Provider Demographics
NPI:1346644267
Name:UNDERWOOD, TAMMY (CNM)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22581
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-2581
Mailing Address - Country:US
Mailing Address - Phone:610-482-4795
Mailing Address - Fax:856-528-3117
Practice Address - Street 1:501 IRON BRIDGE RD STE 10
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-5305
Practice Address - Country:US
Practice Address - Phone:732-431-2999
Practice Address - Fax:732-431-2993
Is Sole Proprietor?:No
Enumeration Date:2014-10-21
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH259607367A00000X
NJ25ME00073200367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife