Provider Demographics
NPI:1508034125
Name:HARRIS, TAMARA TENNILLE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:TENNILLE
Last Name:HARRIS
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 1:5624 WESTCREEK DR
Mailing Address - Street 2:
Mailing Address - City:TROTWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45426-1315
Mailing Address - Country:US
Mailing Address - Phone:937-248-0092
Mailing Address - Fax:
Practice Address - Street 1:5624 WESTCREEK DR
Practice Address - Street 2:
Practice Address - City:TROTWOOD
Practice Address - State:OH
Practice Address - Zip Code:45426-1315
Practice Address - Country:US
Practice Address - Phone:937-248-0092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-16
Last Update Date:2008-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN113809164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse