Provider Demographics
NPI:1356424758
Name:PROUT, TAMMY L (NP)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:L
Last Name:PROUT
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:10601 4TH ST NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-2407
Mailing Address - Country:US
Mailing Address - Phone:505-828-3000
Mailing Address - Fax:505-828-3002
Practice Address - Street 1:1221 PINE GROVE AVE
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3511
Practice Address - Country:US
Practice Address - Phone:810-989-3300
Practice Address - Fax:810-985-2671
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2017-08-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4704173662363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q76509Medicare UPIN