Provider Demographics
NPI:1700227816
Name:RICHARDSON-MANDER, TAMARA NATALIA (RN)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:NATALIA
Last Name:RICHARDSON-MANDER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:TAMARA
Other - Middle Name:NATALIA
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:23 STAHLMAN LN
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-3564
Mailing Address - Country:US
Mailing Address - Phone:347-452-1573
Mailing Address - Fax:
Practice Address - Street 1:23 STAHLMAN LN
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-3564
Practice Address - Country:US
Practice Address - Phone:347-452-1573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY599031-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse