Provider Demographics
NPI:1336242437
Name:ANDRIS, TAMARA MICHELLE (BS)
Entity Type:Individual
Prefix:MISS
First Name:TAMARA
Middle Name:MICHELLE
Last Name:ANDRIS
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 DAVIS BLVD
Mailing Address - Street 2:
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73644-2819
Mailing Address - Country:US
Mailing Address - Phone:580-323-6021
Mailing Address - Fax:
Practice Address - Street 1:90 N 31ST ST.
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:OK
Practice Address - Zip Code:73601
Practice Address - Country:US
Practice Address - Phone:580-323-6021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator