Provider Demographics
NPI:1487836573
Name:WHITE, TAMMY JO (LMP)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:JO
Last Name:WHITE
Suffix:
Gender:F
Credentials:LMP
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 1661
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-6661
Mailing Address - Country:US
Mailing Address - Phone:509-392-2411
Mailing Address - Fax:
Practice Address - Street 1:4001 KENNEDY RD STE 12
Practice Address - Street 2:
Practice Address - City:WEST RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99353-7353
Practice Address - Country:US
Practice Address - Phone:509-628-3745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023416175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath