Provider Demographics
NPI:1184396889
Name:MCDANNALD, TAMMY JO
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:JO
Last Name:MCDANNALD
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:PO BOX 394
Mailing Address - Street 2:
Mailing Address - City:VICI
Mailing Address - State:OK
Mailing Address - Zip Code:73859-0394
Mailing Address - Country:US
Mailing Address - Phone:580-273-4333
Mailing Address - Fax:
Practice Address - Street 1:5050 WILLIAMS AVE
Practice Address - Street 2:
Practice Address - City:WOODWARD
Practice Address - State:OK
Practice Address - Zip Code:73801-7713
Practice Address - Country:US
Practice Address - Phone:580-256-9700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-30
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKL0058618164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse