Provider Demographics
NPI:1689387631
Name:TAMMETTA, RIVER
Entity Type:Individual
Prefix:MS
First Name:RIVER
Middle Name:
Last Name:TAMMETTA
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:PO BOX 18
Mailing Address - Street 2:
Mailing Address - City:POMERENE
Mailing Address - State:AZ
Mailing Address - Zip Code:85627-0018
Mailing Address - Country:US
Mailing Address - Phone:520-428-4224
Mailing Address - Fax:
Practice Address - Street 1:6700 N ORACLE RD STE 505
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-7736
Practice Address - Country:US
Practice Address - Phone:520-330-2334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-04
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ208983163W00000X
AZ289135363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse