Provider Demographics
NPI:1790927853
Name:STONE, TAMMY LYNN (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:LYNN
Last Name:STONE
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:368 OTSEGO ST
Mailing Address - Street 2:
Mailing Address - City:ILION
Mailing Address - State:NY
Mailing Address - Zip Code:13357-2527
Mailing Address - Country:US
Mailing Address - Phone:315-894-6830
Mailing Address - Fax:
Practice Address - Street 1:368 OTSEGO ST
Practice Address - Street 2:
Practice Address - City:ILION
Practice Address - State:NY
Practice Address - Zip Code:13357-2527
Practice Address - Country:US
Practice Address - Phone:315-894-6830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-03
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY544274163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse