Provider Demographics
NPI:1013615756
Name:NORCKAUER, TAMMY RENEE
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:RENEE
Last Name:NORCKAUER
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 1:3431 HICKORY CT
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45434-6013
Mailing Address - Country:US
Mailing Address - Phone:937-307-5437
Mailing Address - Fax:
Practice Address - Street 1:3431 HICKORY CT
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45434-6013
Practice Address - Country:US
Practice Address - Phone:937-307-5437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-22
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0348742Medicaid