Provider Demographics
NPI:1154087849
Name:RISTOW, TAMARA DAWN (BSN RN)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:DAWN
Last Name:RISTOW
Suffix:
Gender:F
Credentials:BSN RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2209 FIDDLERS GREEN CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-6114
Mailing Address - Country:US
Mailing Address - Phone:757-748-9739
Mailing Address - Fax:
Practice Address - Street 1:2209 FIDDLERS GREEN CT
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-6114
Practice Address - Country:US
Practice Address - Phone:757-748-9739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001263172163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse