Provider Demographics
NPI:1295286540
Name:ANDERSON, TAMARA
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:ANDERSON
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 1:437 PALISADE AVE
Mailing Address - Street 2:APT K3
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10703-2420
Mailing Address - Country:US
Mailing Address - Phone:914-776-4661
Mailing Address - Fax:
Practice Address - Street 1:437 PALISADE AVE APT K3
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10703-2412
Practice Address - Country:US
Practice Address - Phone:914-776-4661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-21
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY515047163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse