Provider Demographics
NPI:1639430291
Name:TENNIE, TAMARA
Entity Type:Individual
Prefix:MS
First Name:TAMARA
Middle Name:
Last Name:TENNIE
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 1:5004 STARFINDER AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-4048
Mailing Address - Country:US
Mailing Address - Phone:702-544-9713
Mailing Address - Fax:
Practice Address - Street 1:5004 STARFINDER AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-4048
Practice Address - Country:US
Practice Address - Phone:702-544-9713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner