Provider Demographics
NPI:1396412813
Name:POLLARD, TAMMY L (LPN)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:L
Last Name:POLLARD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15559 OTSEGO PIKE
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:OH
Mailing Address - Zip Code:43569-9767
Mailing Address - Country:US
Mailing Address - Phone:419-410-9077
Mailing Address - Fax:
Practice Address - Street 1:15559 OTSEGO PIKE
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:OH
Practice Address - Zip Code:43569-9767
Practice Address - Country:US
Practice Address - Phone:419-410-9077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-23
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.143771.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse