Provider Demographics
NPI:1851061493
Name:NORRIS, TAMALA (DHA, RN, BSN)
Entity Type:Individual
Prefix:
First Name:TAMALA
Middle Name:
Last Name:NORRIS
Suffix:
Gender:F
Credentials:DHA, RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 N 12TH ST
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76707-3121
Mailing Address - Country:US
Mailing Address - Phone:254-752-5434
Mailing Address - Fax:
Practice Address - Street 1:1115 N 12TH ST
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76707-3121
Practice Address - Country:US
Practice Address - Phone:254-752-5434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX145279310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX04208058OtherDL#