Provider Demographics
NPI:1093554354
Name:LOS, TAMMERA (RN)
Entity type:Individual
Prefix:
First Name:TAMMERA
Middle Name:
Last Name:LOS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TAMMERA
Other - Middle Name:
Other - Last Name:REITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:12549 N WIND RUNNER PKWY
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85658-4705
Mailing Address - Country:US
Mailing Address - Phone:520-528-1535
Mailing Address - Fax:
Practice Address - Street 1:12549 N WIND RUNNER PKWY
Practice Address - Street 2:
Practice Address - City:MARANA
Practice Address - State:AZ
Practice Address - Zip Code:85658-4705
Practice Address - Country:US
Practice Address - Phone:520-528-1535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-24
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN102339163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice