Provider Demographics
NPI:1023651635
Name:FERRELL, TAMARA JO (LPN)
Entity type:Individual
Prefix:MS
First Name:TAMARA
Middle Name:JO
Last Name:FERRELL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:TAMARA
Other - Middle Name:JO
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:763 N 1650 W
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-5066
Mailing Address - Country:US
Mailing Address - Phone:801-704-1372
Mailing Address - Fax:
Practice Address - Street 1:763 N 1650 W
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:UT
Practice Address - Zip Code:84663-5066
Practice Address - Country:US
Practice Address - Phone:801-704-1372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-26
Last Update Date:2019-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10790272-3101164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse