Provider Demographics
NPI:1598321432
Name:LEE, TAMMY SQUIRES
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:SQUIRES
Last Name:LEE
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 1:1820 AMBROSE LN
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27828-9510
Mailing Address - Country:US
Mailing Address - Phone:252-702-3951
Mailing Address - Fax:
Practice Address - Street 1:1820 AMBROSE LN
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:NC
Practice Address - Zip Code:27828-9510
Practice Address - Country:US
Practice Address - Phone:252-702-3951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-16
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No376J00000XNursing Service Related ProvidersHomemaker