Provider Demographics
NPI:1174959696
Name:HAMMOND, TAMARA LEE (LPN)
Entity type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:LEE
Last Name:HAMMOND
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 W HILL RD
Mailing Address - Street 2:STATE RTE 90
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-8116
Mailing Address - Country:US
Mailing Address - Phone:607-423-8383
Mailing Address - Fax:
Practice Address - Street 1:416 W HILL RD
Practice Address - Street 2:STATE RTE 90
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-8116
Practice Address - Country:US
Practice Address - Phone:607-423-8383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-16
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY314918164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse