Provider Demographics
NPI:1710986187
Name:WALBERT, TAMMY S (FNP-BC)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:S
Last Name:WALBERT
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:S
Other - Last Name:CAHALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:100 E CARROLL ST
Mailing Address - Street 2:ATTN: PRMG
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-5422
Mailing Address - Country:US
Mailing Address - Phone:410-543-7531
Mailing Address - Fax:410-912-6386
Practice Address - Street 1:145 E CARROLL ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801
Practice Address - Country:US
Practice Address - Phone:302-539-1026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG-0000356363L00000X
MDR110410363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD409710600OtherMEDICAID MARYLAND
MD1184832040OtherGROUP NPI
DE1000036982Medicaid
DE016152P53Medicare PIN