Provider Demographics
NPI:1336995885
Name:TRAMMEL, TAMIKA LAVONNE
Entity Type:Individual
Prefix:
First Name:TAMIKA
Middle Name:LAVONNE
Last Name:TRAMMEL
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 1:11211 N BLACK CANYON HWY STE 310
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-4759
Mailing Address - Country:US
Mailing Address - Phone:602-459-3224
Mailing Address - Fax:
Practice Address - Street 1:11211 N BLACK CANYON HWY STE 310
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4759
Practice Address - Country:US
Practice Address - Phone:602-459-3224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD07971529172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver