Provider Demographics
NPI:1588329718
Name:DESJARDINS, TAMMY LYNN (LM,CPM,BSM)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:LYNN
Last Name:DESJARDINS
Suffix:
Gender:F
Credentials:LM,CPM,BSM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 E RANDLE AVE
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-4832
Mailing Address - Country:US
Mailing Address - Phone:509-994-8712
Mailing Address - Fax:208-215-2531
Practice Address - Street 1:1415 E RANDLE AVE
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-4832
Practice Address - Country:US
Practice Address - Phone:509-994-8712
Practice Address - Fax:208-215-2531
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-02
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMID-121176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife