Provider Demographics
NPI:1467640813
Name:FRIDLEY, TAMMY LYNN (RN)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:LYNN
Last Name:FRIDLEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:LYNN
Other - Last Name:ROY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:407 LONGVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-3900
Mailing Address - Country:US
Mailing Address - Phone:412-829-0875
Mailing Address - Fax:412-829-8079
Practice Address - Street 1:407 LONGVIEW DR
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-3900
Practice Address - Country:US
Practice Address - Phone:412-829-0875
Practice Address - Fax:412-829-8079
Is Sole Proprietor?:No
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN321503L163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health