Provider Demographics
NPI:1568410470
Name:CHOM, TAMARA ANN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:ANN
Last Name:CHOM
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 1:4090 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:OH
Mailing Address - Zip Code:44081-9625
Mailing Address - Country:US
Mailing Address - Phone:440-259-4236
Mailing Address - Fax:
Practice Address - Street 1:4090 RIVER RD
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:OH
Practice Address - Zip Code:44081-9625
Practice Address - Country:US
Practice Address - Phone:440-259-4236
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.112854164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse