Provider Demographics
NPI:1871191577
Name:BILLITER, TAMMY ROSE
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:ROSE
Last Name:BILLITER
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 1:1307 WILLIAMSTOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26187-8168
Mailing Address - Country:US
Mailing Address - Phone:304-455-2757
Mailing Address - Fax:
Practice Address - Street 1:1307 WILLIAMSTOWN PIKE
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:WV
Practice Address - Zip Code:26187-8168
Practice Address - Country:US
Practice Address - Phone:304-455-2757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-14
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide