Provider Demographics
NPI:1336511195
Name:IHENYEN, TAMARA MAE
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:MAE
Last Name:IHENYEN
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 1:2220 CAPITAL BLVD
Mailing Address - Street 2:STE NO. 206
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609
Mailing Address - Country:US
Mailing Address - Phone:919-803-3101
Mailing Address - Fax:
Practice Address - Street 1:2220 CAPITAL BLVD
Practice Address - Street 2:STE NO. 206
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609
Practice Address - Country:US
Practice Address - Phone:919-803-3101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-20
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4799374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCHC4799OtherSTATE OF NC LICENSE NO.