Provider Demographics
NPI:1841940079
Name:STARR-EVANS, TAMMY BELLE
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:BELLE
Last Name:STARR-EVANS
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 1:15268 MYERS LAKE AVE NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49319-9728
Mailing Address - Country:US
Mailing Address - Phone:616-648-0748
Mailing Address - Fax:
Practice Address - Street 1:15268 MYERS LAKE AVE NE
Practice Address - Street 2:
Practice Address - City:CEDAR SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49319-9728
Practice Address - Country:US
Practice Address - Phone:616-648-0748
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704216670163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse