Provider Demographics
NPI:1780101220
Name:KEYS, TAMARA LYNN (LPN)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:LYNN
Last Name:KEYS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 HICKORY LN
Mailing Address - Street 2:
Mailing Address - City:CENTRAL SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:13036-2622
Mailing Address - Country:US
Mailing Address - Phone:315-676-9070
Mailing Address - Fax:
Practice Address - Street 1:344 HICKORY LANE
Practice Address - Street 2:
Practice Address - City:CENTRAL SQUARE
Practice Address - State:NY
Practice Address - Zip Code:13036
Practice Address - Country:US
Practice Address - Phone:315-676-9070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY329583-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY329583-1OtherLICENSED PRACTICAL NURSE