Provider Demographics
NPI:1306557814
Name:SCHWANINGERBOOSE, TAMMY LYNN (RN)
Entity type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:LYNN
Last Name:SCHWANINGERBOOSE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:TAMMY
Other - Middle Name:LYNN
Other - Last Name:SCHWANINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1011 FORD AVE
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-1701
Mailing Address - Country:US
Mailing Address - Phone:217-347-7600
Mailing Address - Fax:217-342-9733
Practice Address - Street 1:1011 FORD AVE
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-1701
Practice Address - Country:US
Practice Address - Phone:217-347-7600
Practice Address - Fax:217-342-9733
Is Sole Proprietor?:No
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.246402163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse