Provider Demographics
NPI:1487190336
Name:WODEN, TAMMY
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:WODEN
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 1:270 COUNTY HOSPITAL RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:QUINCY
Mailing Address - State:CA
Mailing Address - Zip Code:95971-9180
Mailing Address - Country:US
Mailing Address - Phone:530-283-6307
Mailing Address - Fax:
Practice Address - Street 1:270 COUNTY HOSPITAL RD
Practice Address - Street 2:SUITE 109
Practice Address - City:QUINCY
Practice Address - State:CA
Practice Address - Zip Code:95971-9180
Practice Address - Country:US
Practice Address - Phone:530-283-6307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-17
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator