Provider Demographics
NPI:1588007850
Name:DURCAN, TAMARA A (STNA)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:A
Last Name:DURCAN
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:MRS
Other - First Name:TAMI
Other - Middle Name:A
Other - Last Name:DURCAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:STNA
Mailing Address - Street 1:508 CIDER MILL WAY
Mailing Address - Street 2:
Mailing Address - City:TIPP CITY
Mailing Address - State:OH
Mailing Address - Zip Code:45371-2492
Mailing Address - Country:US
Mailing Address - Phone:937-558-2741
Mailing Address - Fax:
Practice Address - Street 1:508 CIDER MILL WAY
Practice Address - Street 2:
Practice Address - City:TIPP CITY
Practice Address - State:OH
Practice Address - Zip Code:45371-2492
Practice Address - Country:US
Practice Address - Phone:937-558-2741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401501220413376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide