Provider Demographics
NPI:1336915222
Name:SUITER, TAMMY JEAN
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:JEAN
Last Name:SUITER
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 1:7276 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:LOWVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13367-3815
Mailing Address - Country:US
Mailing Address - Phone:315-921-4821
Mailing Address - Fax:
Practice Address - Street 1:7276 RIVER RD
Practice Address - Street 2:
Practice Address - City:LOWVILLE
Practice Address - State:NY
Practice Address - Zip Code:13367-3815
Practice Address - Country:US
Practice Address - Phone:315-921-4821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY487852163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty