Provider Demographics
NPI:1265839740
Name:DAVID, TAMMIE
Entity Type:Individual
Prefix:
First Name:TAMMIE
Middle Name:
Last Name:DAVID
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:NORTH OF CHURCH 69
Mailing Address - Street 2:
Mailing Address - City:ELIM
Mailing Address - State:AK
Mailing Address - Zip Code:99739
Mailing Address - Country:US
Mailing Address - Phone:907-890-3311
Mailing Address - Fax:907-890-2280
Practice Address - Street 1:NORTH OF CHURCH 69
Practice Address - Street 2:
Practice Address - City:ELIM
Practice Address - State:AK
Practice Address - Zip Code:99739
Practice Address - Country:US
Practice Address - Phone:907-890-3311
Practice Address - Fax:907-890-2280
Is Sole Proprietor?:No
Enumeration Date:2014-11-26
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCHA IIOtherCHA II