Provider Demographics
NPI:1295535904
Name:STEVENS, TAMMY MARIE (CAREGIVER)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:MARIE
Last Name:STEVENS
Suffix:
Gender:
Credentials:CAREGIVER
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:MARIE
Other - Last Name:HARRAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1302
Mailing Address - Street 2:
Mailing Address - City:MC COOK
Mailing Address - State:NE
Mailing Address - Zip Code:69001-1302
Mailing Address - Country:US
Mailing Address - Phone:360-561-9466
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 1302
Practice Address - Street 2:
Practice Address - City:MC COOK
Practice Address - State:NE
Practice Address - Zip Code:69001-1302
Practice Address - Country:US
Practice Address - Phone:360-561-9466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE33408529372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider