Provider Demographics
NPI:1316438625
Name:THOMPSON MOORE, TAMARA NAOMI (CLC)
Entity type:Individual
Prefix:MS
First Name:TAMARA
Middle Name:NAOMI
Last Name:THOMPSON MOORE
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W380N6297 N LAKE RD
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-5910
Mailing Address - Country:US
Mailing Address - Phone:608-320-3874
Mailing Address - Fax:
Practice Address - Street 1:8 STRAUBEL CT STE 100
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-4104
Practice Address - Country:US
Practice Address - Phone:608-535-9525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-22
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Multi-Specialty
No175M00000XOther Service ProvidersMidwife, LayGroup - Multi-Specialty
No372500000XNursing Service Related ProvidersChore Provider
No374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty