Provider Demographics
NPI:1750890125
Name:WELLINGTON, TAMARA MARCIA
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:MARCIA
Last Name:WELLINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:MARCIA
Other - Last Name:WELLINGTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:129 W OAKS MALL
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-1765
Mailing Address - Country:US
Mailing Address - Phone:832-859-7311
Mailing Address - Fax:832-288-4330
Practice Address - Street 1:129 W OAKS MALL
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-1765
Practice Address - Country:US
Practice Address - Phone:832-859-7311
Practice Address - Fax:832-288-4330
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX376K00000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty