Provider Demographics
NPI:1720008303
Name:HANSFORD, TAMRA L (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:TAMRA
Middle Name:L
Last Name:HANSFORD
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:41 HUNT CLUB PLZ
Mailing Address - Street 2:
Mailing Address - City:RIDGELEY
Mailing Address - State:WV
Mailing Address - Zip Code:26753-5213
Mailing Address - Country:US
Mailing Address - Phone:304-726-4253
Mailing Address - Fax:304-726-4187
Practice Address - Street 1:144 FIFTH AVENUE
Practice Address - Street 2:
Practice Address - City:HYNDMAN
Practice Address - State:PA
Practice Address - Zip Code:15545
Practice Address - Country:US
Practice Address - Phone:814-842-3206
Practice Address - Fax:814-842-9169
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN47950363LX0001X
PASP009789363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology