Provider Demographics
NPI:1134740244
Name:STANIC, TAMARA SUE (RN, CDCES)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:SUE
Last Name:STANIC
Suffix:
Gender:F
Credentials:RN, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2940 SAN JOSE AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-6972
Mailing Address - Country:US
Mailing Address - Phone:559-977-6899
Mailing Address - Fax:559-459-1524
Practice Address - Street 1:215 N. FRESNO STREET, SUITE 370
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93701
Practice Address - Country:US
Practice Address - Phone:559-459-4543
Practice Address - Fax:559-459-1524
Is Sole Proprietor?:No
Enumeration Date:2020-04-29
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA377376163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA377376OtherCALIFORNIA BOARD OF REGISTERED NURSING