Provider Demographics
NPI:1649866443
Name:KAUFFMAN, TAMMY SUE (EMT/PHLEBOTOMIST)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:SUE
Last Name:KAUFFMAN
Suffix:
Gender:F
Credentials:EMT/PHLEBOTOMIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2751 E MULLETT LAKE RD
Mailing Address - Street 2:
Mailing Address - City:INDIAN RIVER
Mailing Address - State:MI
Mailing Address - Zip Code:49749-9181
Mailing Address - Country:US
Mailing Address - Phone:231-818-5344
Mailing Address - Fax:
Practice Address - Street 1:2751 E MULLETT LAKE RD
Practice Address - Street 2:
Practice Address - City:INDIAN RIVER
Practice Address - State:MI
Practice Address - Zip Code:49749-9181
Practice Address - Country:US
Practice Address - Phone:231-818-5344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI511592146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic