Provider Demographics
NPI:1972626679
Name:TURNBULL, TAMARA L (LMT, RN)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:L
Last Name:TURNBULL
Suffix:
Gender:F
Credentials:LMT, RN
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:
Other - Last Name:TURNBULL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT, RN
Mailing Address - Street 1:1509 AMERICAN WAY
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-4561
Mailing Address - Country:US
Mailing Address - Phone:505-443-0734
Mailing Address - Fax:
Practice Address - Street 1:1509 AMERICAN WAY
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-4561
Practice Address - Country:US
Practice Address - Phone:505-443-0734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2595172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM2595OtherMASSAGE THERAPY LICENSE