Provider Demographics
NPI:1356841092
Name:TAMO, VIVIAN NGEGAH
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:NGEGAH
Last Name:TAMO
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 1:4307 PALMER DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-3433
Mailing Address - Country:US
Mailing Address - Phone:651-332-4329
Mailing Address - Fax:
Practice Address - Street 1:1008 BELVEDERE DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76010-2926
Practice Address - Country:US
Practice Address - Phone:651-332-4329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX844800163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health