Provider Demographics
NPI:1740805944
Name:USEDO, TAMMARA ELENA (CPM, LM)
Entity Type:Individual
Prefix:
First Name:TAMMARA
Middle Name:ELENA
Last Name:USEDO
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28003 ELEYS FORD RD
Mailing Address - Street 2:
Mailing Address - City:RICHARDSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22736-1740
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:28003 ELEYS FORD RD
Practice Address - Street 2:
Practice Address - City:RICHARDSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22736-1740
Practice Address - Country:US
Practice Address - Phone:203-224-0963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-12
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0129000150176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife