Provider Demographics
NPI:1568069151
Name:PRIMM, TOMASINA ANTONETTE
Entity Type:Individual
Prefix:
First Name:TOMASINA
Middle Name:ANTONETTE
Last Name:PRIMM
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:PO BOX 82
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-0082
Mailing Address - Country:US
Mailing Address - Phone:304-952-0192
Mailing Address - Fax:
Practice Address - Street 1:901 CHRISTIE AVE
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2505
Practice Address - Country:US
Practice Address - Phone:304-952-0192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant