Provider Demographics
NPI:1467767517
Name:GRODON, TAMMY LYNN (LPN)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:LYNN
Last Name:GRODON
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:PO BOX 427
Mailing Address - Street 2:
Mailing Address - City:ANGELICA
Mailing Address - State:NY
Mailing Address - Zip Code:14709-0427
Mailing Address - Country:US
Mailing Address - Phone:585-808-8213
Mailing Address - Fax:
Practice Address - Street 1:4638 NOBLES RD
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:NY
Practice Address - Zip Code:14813-9722
Practice Address - Country:US
Practice Address - Phone:585-268-7003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-13
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2940791164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse