Individual
TAMI LYNN WACKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
1303 N CANAL ST APT 28, CARLSBAD, NM 88220-4668
(575) 302-1666
Mailing address
1303 N CANAL ST APT 28, CARLSBAD, NM 88220-4668
(575) 302-1666
Taxonomy
Speciality
Code
Description
License number
State
376G00000X
Nursing Home Administrator
Primary
044.011785
IL
Other
Enumeration date
04/25/2024
Last updated
12/12/2024
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