Provider Demographics
NPI:1194322685
Name:HOLLMAN, TAMARA S
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:S
Last Name:HOLLMAN
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:PO BOX 124
Mailing Address - Street 2:
Mailing Address - City:LYONS
Mailing Address - State:MI
Mailing Address - Zip Code:48851-0124
Mailing Address - Country:US
Mailing Address - Phone:616-252-9884
Mailing Address - Fax:
Practice Address - Street 1:217 JOHN ST
Practice Address - Street 2:
Practice Address - City:LYONS
Practice Address - State:MI
Practice Address - Zip Code:48851-5101
Practice Address - Country:US
Practice Address - Phone:616-252-9884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-07
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704229510163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse