Provider Demographics
NPI:1518570191
Name:DALTON, TAMMY REGINA
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:REGINA
Last Name:DALTON
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 1:346 FRANCES CRK
Mailing Address - Street 2:
Mailing Address - City:HARTS
Mailing Address - State:WV
Mailing Address - Zip Code:25524-8064
Mailing Address - Country:US
Mailing Address - Phone:304-855-1047
Mailing Address - Fax:
Practice Address - Street 1:346 FRANCES CRK
Practice Address - Street 2:
Practice Address - City:HARTS
Practice Address - State:WV
Practice Address - Zip Code:25524-8064
Practice Address - Country:US
Practice Address - Phone:304-855-1047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant