Provider Demographics
NPI:1295290948
Name:KANKOWSKI, TAMARA TAMARA
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:TAMARA
Last Name:KANKOWSKI
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 1:1789 GREENTREE MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-4008
Mailing Address - Country:US
Mailing Address - Phone:513-254-9081
Mailing Address - Fax:
Practice Address - Street 1:1789 GREENTREE MEADOWS DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-4008
Practice Address - Country:US
Practice Address - Phone:513-254-2470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-07
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHTKA-104487374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula