Provider Demographics
NPI:1750477675
Name:WILBURN, TAMMY SUE (LPN)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:SUE
Last Name:WILBURN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4408 CLINES CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:OH
Mailing Address - Zip Code:45690-8925
Mailing Address - Country:US
Mailing Address - Phone:740-835-8273
Mailing Address - Fax:
Practice Address - Street 1:4408 CLINES CHAPEL RD
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:OH
Practice Address - Zip Code:45690-8925
Practice Address - Country:US
Practice Address - Phone:740-835-8273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN113571164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse