Individual
TAMMY RICHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
787 N 11TH ST, COTTAGE GROVE, OR 97424-1336
(970) 290-9936
Mailing address
787 N 11TH ST, COTTAGE GROVE, OR 97424-1336
(970) 290-9936
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
200930285
OR
Other
Enumeration date
11/04/2014
Last updated
11/04/2014
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