Provider Demographics
NPI:1558344929
Name:HISE, TAMARA S (RN)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:S
Last Name:HISE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:S
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:29335 GARY DR
Mailing Address - Street 2:
Mailing Address - City:WORLEY
Mailing Address - State:ID
Mailing Address - Zip Code:83876
Mailing Address - Country:US
Mailing Address - Phone:208-686-1157
Mailing Address - Fax:
Practice Address - Street 1:1100 A ST
Practice Address - Street 2:
Practice Address - City:PLUMMER
Practice Address - State:ID
Practice Address - Zip Code:83851
Practice Address - Country:US
Practice Address - Phone:208-686-1931
Practice Address - Fax:208-686-8052
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN16204163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse