Provider Demographics
NPI:1366792160
Name:KIMPLAND, TAMMY LYNNE (RN)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:LYNNE
Last Name:KIMPLAND
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 SCOTT DR
Mailing Address - Street 2:
Mailing Address - City:HANNIBAL
Mailing Address - State:NY
Mailing Address - Zip Code:13074-2108
Mailing Address - Country:US
Mailing Address - Phone:315-564-7337
Mailing Address - Fax:315-564-7980
Practice Address - Street 1:846 CAYUGA ST
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:NY
Practice Address - Zip Code:13074-3152
Practice Address - Country:US
Practice Address - Phone:315-564-7960
Practice Address - Fax:315-564-7980
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY415320163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool