Provider Demographics
NPI:1891312641
Name:ZOLLER, TAMMY DIANA
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:DIANA
Last Name:ZOLLER
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 1:5406 W 90TH ST N
Mailing Address - Street 2:
Mailing Address - City:PORTER
Mailing Address - State:OK
Mailing Address - Zip Code:74454-2696
Mailing Address - Country:US
Mailing Address - Phone:918-521-3612
Mailing Address - Fax:
Practice Address - Street 1:10501 E 91ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5790
Practice Address - Country:US
Practice Address - Phone:918-307-6390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-28
Last Update Date:2020-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK78080163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant