Provider Demographics
NPI:1164038196
Name:SMITH, TAMMY E
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:E
Last Name:SMITH
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 1:1500 KAREN AVE
Mailing Address - Street 2:65
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169
Mailing Address - Country:US
Mailing Address - Phone:385-312-7425
Mailing Address - Fax:
Practice Address - Street 1:1500 KAREN AVE
Practice Address - Street 2:65
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169
Practice Address - Country:US
Practice Address - Phone:385-312-7425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health