Provider Demographics
NPI:1346745205
Name:BACH, TAMARA SUE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:SUE
Last Name:BACH
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 FEATHER WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82930-9352
Mailing Address - Country:US
Mailing Address - Phone:307-200-9200
Mailing Address - Fax:307-200-4808
Practice Address - Street 1:195 FEATHER WAY STE 100
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82930-9352
Practice Address - Country:US
Practice Address - Phone:307-200-9200
Practice Address - Fax:307-200-4808
Is Sole Proprietor?:No
Enumeration Date:2018-03-24
Last Update Date:2018-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY22296.1641364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health