Provider Demographics
NPI:1265709810
Name:GUIDO, TAMBRE L
Entity type:Individual
Prefix:
First Name:TAMBRE
Middle Name:L
Last Name:GUIDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:L
Other - Last Name:GUIDO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DHAT/RDH
Mailing Address - Street 1:PO BOX 414
Mailing Address - Street 2:
Mailing Address - City:HOOPER BAY
Mailing Address - State:AK
Mailing Address - Zip Code:99604-0414
Mailing Address - Country:US
Mailing Address - Phone:190-758-3504
Mailing Address - Fax:
Practice Address - Street 1:49 AIRPORT ROAD
Practice Address - Street 2:
Practice Address - City:HOOPER BAY
Practice Address - State:AK
Practice Address - Zip Code:99604
Practice Address - Country:US
Practice Address - Phone:907-758-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK10-061247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other