Provider Demographics
NPI:1447741285
Name:WASINGER, TAMARA (LPN)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:WASINGER
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 1:3472 RESEARCH PKWY STE 104-652
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-1066
Mailing Address - Country:US
Mailing Address - Phone:719-494-9779
Mailing Address - Fax:
Practice Address - Street 1:3472 RESEARCH PKWY STE 104-652
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-1066
Practice Address - Country:US
Practice Address - Phone:719-494-9779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPN.0029991164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse