Provider Demographics
NPI:1689845885
Name:MCCLURE, TAMMY M (LPN)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:M
Last Name:MCCLURE
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 1:9628 SMART RD
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45133-8669
Mailing Address - Country:US
Mailing Address - Phone:937-393-2079
Mailing Address - Fax:937-393-2079
Practice Address - Street 1:9628 SMART RD
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OH
Practice Address - Zip Code:45133-8669
Practice Address - Country:US
Practice Address - Phone:937-393-2079
Practice Address - Fax:937-393-2079
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN104854164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse