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Individual
TAMMIE LOU MUSTARD
Active
Individual
TAMMIE LOU MUSTARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
090929
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0959459
—
OH
Enumeration date
02/04/2020
Last updated
02/04/2020
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