Provider Demographics
NPI:1235579236
Name:HECTUS, TAMARA LYNN
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:LYNN
Last Name:HECTUS
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 1:301 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:NY
Mailing Address - Zip Code:13340-1421
Mailing Address - Country:US
Mailing Address - Phone:315-868-3554
Mailing Address - Fax:
Practice Address - Street 1:301 3RD AVE
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:NY
Practice Address - Zip Code:13340-1421
Practice Address - Country:US
Practice Address - Phone:315-868-3554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-05
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY307018164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse