Provider Demographics
NPI:1659419778
Name:MATT, TAMMY LYNN (RN BSN)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:LYNN
Last Name:MATT
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 880
Mailing Address - Street 2:
Mailing Address - City:ST IGNATIUS
Mailing Address - State:MT
Mailing Address - Zip Code:59865-0880
Mailing Address - Country:US
Mailing Address - Phone:406-726-3224
Mailing Address - Fax:406-726-4023
Practice Address - Street 1:11 BITTERROOT JIM LANE
Practice Address - Street 2:
Practice Address - City:ARLEE
Practice Address - State:MT
Practice Address - Zip Code:59821
Practice Address - Country:US
Practice Address - Phone:406-726-3224
Practice Address - Fax:406-726-4023
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN23397163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health