Provider Demographics
NPI:1740783182
Name:ZUMWALT, TAMMY PIERCE
Entity type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:PIERCE
Last Name:ZUMWALT
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 1:1507 S SANTA CRUZ ST
Mailing Address - Street 2:
Mailing Address - City:DEMING
Mailing Address - State:NM
Mailing Address - Zip Code:88030-6012
Mailing Address - Country:US
Mailing Address - Phone:575-805-0063
Mailing Address - Fax:
Practice Address - Street 1:1507 S SANTA CRUZ ST
Practice Address - Street 2:
Practice Address - City:DEMING
Practice Address - State:NM
Practice Address - Zip Code:88030-6012
Practice Address - Country:US
Practice Address - Phone:575-805-0063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-12
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician