Provider Demographics
NPI:1770889180
Name:TAMARA, AURA LUCIA (NLMT)
Entity type:Individual
Prefix:
First Name:AURA
Middle Name:LUCIA
Last Name:TAMARA
Suffix:
Gender:F
Credentials:NLMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 MEDICAL CT
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-2843
Mailing Address - Country:US
Mailing Address - Phone:304-267-4041
Mailing Address - Fax:
Practice Address - Street 1:305 MEDICAL CT
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-2843
Practice Address - Country:US
Practice Address - Phone:304-267-4041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-02
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20112806174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist