Provider Demographics
NPI:1366042343
Name:WASHINGTON, TAMARA (RN)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2516 E WILLOW ST UNIT 201
Mailing Address - Street 2:
Mailing Address - City:SIGNAL HILL
Mailing Address - State:CA
Mailing Address - Zip Code:90755-6328
Mailing Address - Country:US
Mailing Address - Phone:310-749-0032
Mailing Address - Fax:
Practice Address - Street 1:2516 E WILLOW ST UNIT 201
Practice Address - Street 2:
Practice Address - City:SIGNAL HILL
Practice Address - State:CA
Practice Address - Zip Code:90755-6328
Practice Address - Country:US
Practice Address - Phone:310-749-0032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA490052163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty