Provider Demographics
NPI:1982986147
Name:PUTMAN, TAMERA RENEA
Entity Type:Individual
Prefix:MRS
First Name:TAMERA
Middle Name:RENEA
Last Name:PUTMAN
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:PO BOX 15
Mailing Address - Street 2:
Mailing Address - City:RAVIA
Mailing Address - State:OK
Mailing Address - Zip Code:73455-0015
Mailing Address - Country:US
Mailing Address - Phone:580-369-1561
Mailing Address - Fax:
Practice Address - Street 1:405 W A AVE
Practice Address - Street 2:
Practice Address - City:RAVIA
Practice Address - State:OK
Practice Address - Zip Code:73455-0015
Practice Address - Country:US
Practice Address - Phone:580-369-1561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK37H013851108376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide