Individual
TAMMY SUE WALRATH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
201 DATES DR, ITHACA, NY 14850-1345
(607) 844-7271
Mailing address
201 DATES DR, ITHACA, NY 14850-1345
(607) 844-7271
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
022900
NY
363AM0700X
Medical Physician Assistant
Primary
022900
NY
Other
Enumeration date
10/24/2018
Last updated
01/13/2021
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