Provider Demographics
NPI:1588853741
Name:VANDERMOLEN, TAMMY LEE ANN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:LEE ANN
Last Name:VANDERMOLEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:TAMMY
Other - Middle Name:LEE ANN
Other - Last Name:BARTHOLOMEW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:4 MEMORIAL DR STE 230
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-6704
Mailing Address - Country:US
Mailing Address - Phone:618-463-7777
Mailing Address - Fax:
Practice Address - Street 1:4 MEMORIAL DR STE 230
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-6704
Practice Address - Country:US
Practice Address - Phone:618-463-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002016318363LF0000X
IL209019527363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily