Provider Demographics
NPI:1821461393
Name:WYMAN, TAMMY (CMA)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:WYMAN
Suffix:
Gender:F
Credentials:CMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 500
Mailing Address - Street 2:
Mailing Address - City:PATTEN
Mailing Address - State:ME
Mailing Address - Zip Code:04765-0500
Mailing Address - Country:US
Mailing Address - Phone:207-528-2285
Mailing Address - Fax:207-528-2880
Practice Address - Street 1:30 HOULTON ST
Practice Address - Street 2:
Practice Address - City:PATTEN
Practice Address - State:ME
Practice Address - Zip Code:04765-0500
Practice Address - Country:US
Practice Address - Phone:207-528-2285
Practice Address - Fax:207-528-2880
Is Sole Proprietor?:No
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program