Provider Demographics
NPI:1467158253
Name:MISCHE, TAMMY
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:MISCHE
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 1:3451 SAINT ALBANS RD # 106
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:MO
Mailing Address - Zip Code:63073-1237
Mailing Address - Country:US
Mailing Address - Phone:636-262-9117
Mailing Address - Fax:
Practice Address - Street 1:408 JUNGERMANN RD
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-2799
Practice Address - Country:US
Practice Address - Phone:636-449-5757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014022770163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator