Provider Demographics
NPI:1629549159
Name:YOAS, TAMARA DAWN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:DAWN
Last Name:YOAS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46960 VAN DYKE AVE # 8144
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48317-4378
Mailing Address - Country:US
Mailing Address - Phone:586-726-9220
Mailing Address - Fax:
Practice Address - Street 1:46960 VAN DYKE AVE # 8144
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48317-4378
Practice Address - Country:US
Practice Address - Phone:586-726-9220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-10
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3016157363L00000X
OR202104987RN363L00000X
MI4704267084363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily