Provider Demographics
NPI:1245560366
Name:LATHEY, TAMMY LYNN (LPN)
Entity type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:LYNN
Last Name:LATHEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 TRACEY LN
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-1216
Mailing Address - Country:US
Mailing Address - Phone:315-491-4885
Mailing Address - Fax:
Practice Address - Street 1:126 TRACEY LN
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-1216
Practice Address - Country:US
Practice Address - Phone:315-491-4885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY243147-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse