Provider Demographics
NPI:1265502843
Name:SMOOT, TAMMY LYNN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:LYNN
Last Name:SMOOT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 S STEPHENSON AVE
Mailing Address - Street 2:SUITE 215
Mailing Address - City:IRON MOUNTAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49801-3639
Mailing Address - Country:US
Mailing Address - Phone:906-776-5843
Mailing Address - Fax:906-774-3324
Practice Address - Street 1:1711 S STEPHENSON AVE
Practice Address - Street 2:SUITE 215
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801-3639
Practice Address - Country:US
Practice Address - Phone:906-776-5843
Practice Address - Fax:906-774-3324
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703055801164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4703055801OtherPRACTICAL NURSE LICENSE