Provider Demographics
NPI:1982858619
Name:LANSING, TAMARA (LPN)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:LANSING
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:
Other - Last Name:LANSING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:13582 MCGIBBON RD
Mailing Address - Street 2:
Mailing Address - City:MARTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13111-4106
Mailing Address - Country:US
Mailing Address - Phone:315-406-1485
Mailing Address - Fax:
Practice Address - Street 1:13582 MCGIBBON RD
Practice Address - Street 2:
Practice Address - City:MARTVILLE
Practice Address - State:NY
Practice Address - Zip Code:13111-4106
Practice Address - Country:US
Practice Address - Phone:315-406-1485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-07
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY294385164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse