Provider Demographics
NPI:1225848708
Name:GOODRICH, TAMARA LEE (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:LEE
Last Name:GOODRICH
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2711 W 450 N APT 4F
Mailing Address - Street 2:
Mailing Address - City:TREMONTON
Mailing Address - State:UT
Mailing Address - Zip Code:84337-2612
Mailing Address - Country:US
Mailing Address - Phone:435-282-6195
Mailing Address - Fax:
Practice Address - Street 1:2711 W 450 N APT 4F
Practice Address - Street 2:
Practice Address - City:TREMONTON
Practice Address - State:UT
Practice Address - Zip Code:84337-2612
Practice Address - Country:US
Practice Address - Phone:435-282-6195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT362490-3102163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse