Provider Demographics
NPI:1740291483
Name:TRICE, TAMYRA N (PA-C)
Entity type:Individual
Prefix:
First Name:TAMYRA
Middle Name:N
Last Name:TRICE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TAMYRA
Other - Middle Name:N
Other - Last Name:BERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 80257
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53208-8004
Mailing Address - Country:US
Mailing Address - Phone:414-935-8000
Mailing Address - Fax:414-344-3396
Practice Address - Street 1:1452 N 7TH ST FL 2
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53205
Practice Address - Country:US
Practice Address - Phone:414-935-8000
Practice Address - Fax:414-287-0907
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2023-023363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI501435OtherMEDICARE CLINIC NUMBER
WI521821Medicare ID - Type Unspecified