Provider Demographics
NPI:1134679772
Name:WINGFIELD, TAMMY
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:WINGFIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 N SANTA FE TRL
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-6734
Mailing Address - Country:US
Mailing Address - Phone:623-547-1018
Mailing Address - Fax:623-935-2108
Practice Address - Street 1:3300 N SANTA FE TRL
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-6734
Practice Address - Country:US
Practice Address - Phone:623-547-1018
Practice Address - Fax:623-935-2108
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-06
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP043164164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse