Provider Demographics
NPI:1467510099
Name:HAIRSTON, TAMRA LANETTE (RN BSN)
Entity Type:Individual
Prefix:MS
First Name:TAMRA
Middle Name:LANETTE
Last Name:HAIRSTON
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5022 EASY CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43231-4895
Mailing Address - Country:US
Mailing Address - Phone:614-895-9064
Mailing Address - Fax:
Practice Address - Street 1:5022 EASY CT
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231-4895
Practice Address - Country:US
Practice Address - Phone:614-895-9064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-269428163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse