Provider Demographics
NPI:1689866402
Name:DEWEES, TAMARA LYNN (PTA)
Entity Type:Individual
Prefix:MS
First Name:TAMARA
Middle Name:LYNN
Last Name:DEWEES
Suffix:
Gender:F
Credentials:PTA
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 61
Mailing Address - Street 2:
Mailing Address - City:KENESAW
Mailing Address - State:NE
Mailing Address - Zip Code:68956-0061
Mailing Address - Country:US
Mailing Address - Phone:402-752-3631
Mailing Address - Fax:
Practice Address - Street 1:926 E E ST
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-6617
Practice Address - Country:US
Practice Address - Phone:402-463-3181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-15
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE215314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility