Provider Demographics
NPI:1801225511
Name:TAM, LAUREL (PNP)
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:
Last Name:TAM
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 GELLERT BLVD
Mailing Address - Street 2:SUITE 229
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-2621
Mailing Address - Country:US
Mailing Address - Phone:650-992-8668
Mailing Address - Fax:
Practice Address - Street 1:333 GELLERT BLVD
Practice Address - Street 2:SUITE 229
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2621
Practice Address - Country:US
Practice Address - Phone:650-992-8668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-03
Last Update Date:2013-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA754225163W00000X
CA23354363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse