Provider Demographics
NPI:1659778553
Name:LADURON, TAMMY (LPN)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:
Last Name:LADURON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1648 S 63RD ST
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53214-5014
Mailing Address - Country:US
Mailing Address - Phone:414-551-4210
Mailing Address - Fax:866-317-4218
Practice Address - Street 1:1648 S 63RD ST
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214-5014
Practice Address - Country:US
Practice Address - Phone:414-551-4210
Practice Address - Fax:866-317-4218
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-21
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI303034-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse