Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | R097322 | MD |
NPI | 1053309203 |
---|---|
Provider Name | Tammy Tenace |
First Address | Shaw A F B, SC 29152-1310 |
Second Address | Shaw A F B, SC 29152-5019 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2005 |
Last Update Date | 08/07/2007 |