Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | COA.18661-NP | OH |
NPI | 1073988598 |
---|---|
Provider Name | Mrs. Tamara Lynn King |
First Address | Dayton, OH 45409-2722 |
Second Address | Dayton, OH 45409-2722 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2015 |
Last Update Date | 04/04/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0156508 | (05) | OH |