Provider Demographics
NPI:1740941392
Name:DAHL, TAMERA JO
Entity type:Individual
Prefix:
First Name:TAMERA
Middle Name:JO
Last Name:DAHL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:
Other - Last Name:BLECHA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7116 DIAMOND
Mailing Address - Street 2:
Mailing Address - City:BURR OAK
Mailing Address - State:KS
Mailing Address - Zip Code:66936-1658
Mailing Address - Country:US
Mailing Address - Phone:785-647-2088
Mailing Address - Fax:
Practice Address - Street 1:3667 ROAD C
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:NE
Practice Address - Zip Code:68978-7143
Practice Address - Country:US
Practice Address - Phone:785-647-2088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider