Provider Demographics
NPI:1558939710
Name:WHITAKER, TAMMY MARIE (RN)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:MARIE
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:LINDSEY
Mailing Address - State:OH
Mailing Address - Zip Code:43442-3006
Mailing Address - Country:US
Mailing Address - Phone:419-463-7081
Mailing Address - Fax:419-332-8404
Practice Address - Street 1:1247 N RIVER RD
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-9760
Practice Address - Country:US
Practice Address - Phone:410-332-0357
Practice Address - Fax:419-332-8404
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN469435163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice