Provider Demographics
NPI:1316748866
Name:BROWN, TAMARA DANETTE
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:DANETTE
Last Name:BROWN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 CALDWELL ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-1617
Mailing Address - Country:US
Mailing Address - Phone:402-218-5845
Mailing Address - Fax:
Practice Address - Street 1:2424 CALDWELL ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-1617
Practice Address - Country:US
Practice Address - Phone:402-218-5845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEH12836747172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver