Provider Demographics
NPI:1851037980
Name:LANMON, TAMARA LEE
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:LEE
Last Name:LANMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:771 BADGER RD STE 205
Mailing Address - Street 2:
Mailing Address - City:NORTH POLE
Mailing Address - State:AK
Mailing Address - Zip Code:99705-5710
Mailing Address - Country:US
Mailing Address - Phone:907-371-8244
Mailing Address - Fax:
Practice Address - Street 1:771 BADGER RD STE 205
Practice Address - Street 2:
Practice Address - City:NORTH POLE
Practice Address - State:AK
Practice Address - Zip Code:99705-5710
Practice Address - Country:US
Practice Address - Phone:907-371-8244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-11
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK191954225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist