Provider Demographics
NPI:1932490232
Name:WAKEFIELD, TAMARA NICOLE (RN)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:NICOLE
Last Name:WAKEFIELD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:644 JODEE DR
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-5919
Mailing Address - Country:US
Mailing Address - Phone:937-372-4366
Mailing Address - Fax:
Practice Address - Street 1:644 JODEE DR
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-5919
Practice Address - Country:US
Practice Address - Phone:937-372-4366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-21
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 331844163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse