Provider Demographics
NPI:1760769947
Name:HARRELL, TAMARA (LPN)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:HARRELL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:
Other - Last Name:CHERRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:1 E HAYESTOWN RD UNIT 52
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06811-2512
Mailing Address - Country:US
Mailing Address - Phone:914-373-9813
Mailing Address - Fax:
Practice Address - Street 1:1 E HAYESTOWN RD UNIT 52
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06811-2512
Practice Address - Country:US
Practice Address - Phone:914-373-9813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-15
Last Update Date:2022-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT40533164W00000X
NY294865164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse