Provider Demographics
NPI:1275743395
Name:FAHNLANDER, TAMI RAE (DO)
Entity Type:Individual
Prefix:
First Name:TAMI
Middle Name:RAE
Last Name:FAHNLANDER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12339 STRATFORD DR
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-8148
Mailing Address - Country:US
Mailing Address - Phone:515-263-8569
Mailing Address - Fax:
Practice Address - Street 1:12339 STRATFORD DR
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-8148
Practice Address - Country:US
Practice Address - Phone:515-263-8569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125-047470207V00000X
IA3778207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology