Provider Demographics
NPI:1316361645
Name:SCHOONHOVEN, TAMMIE SUE (CNA)
Entity Type:Individual
Prefix:
First Name:TAMMIE
Middle Name:SUE
Last Name:SCHOONHOVEN
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1244 TENNESSEE AVE
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-8673
Mailing Address - Country:US
Mailing Address - Phone:719-315-2162
Mailing Address - Fax:719-458-1649
Practice Address - Street 1:1244 TENNESSEE AVE
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-8673
Practice Address - Country:US
Practice Address - Phone:719-315-2162
Practice Address - Fax:719-458-1649
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO22787164W00000X
CO172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No172V00000XOther Service ProvidersCommunity Health Worker