Provider Demographics
NPI:1487129599
Name:WINDUS, TAMARA
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:WINDUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6075 COUNTY ROAD 31A
Mailing Address - Street 2:
Mailing Address - City:SCIO
Mailing Address - State:NY
Mailing Address - Zip Code:14880-9756
Mailing Address - Country:US
Mailing Address - Phone:585-610-9989
Mailing Address - Fax:
Practice Address - Street 1:6075 COUNTY ROAD 31A
Practice Address - Street 2:
Practice Address - City:SCIO
Practice Address - State:NY
Practice Address - Zip Code:14880-9756
Practice Address - Country:US
Practice Address - Phone:585-610-9989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-05
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY331681-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY331681-1OtherLPN LICSENSE