Provider Demographics
NPI:1407073489
Name:MACDONALD, TAMARA ANN (ND LAC)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:ANN
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:ND LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1814 PEARL RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212
Mailing Address - Country:US
Mailing Address - Phone:330-460-5155
Mailing Address - Fax:330-460-5155
Practice Address - Street 1:1814 PEARL RD
Practice Address - Street 2:SUITE B
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212
Practice Address - Country:US
Practice Address - Phone:330-460-5155
Practice Address - Fax:330-460-5155
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH126171100000X
WANT1179175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist