Provider Demographics
NPI:1720158249
Name:EVANS, TAMARA CULLEN (ND)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:CULLEN
Last Name:EVANS
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:JEAN
Other - Last Name:CULLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ND
Mailing Address - Street 1:4411 FREMONT AVE N.
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103
Mailing Address - Country:US
Mailing Address - Phone:206-683-4495
Mailing Address - Fax:206-547-2207
Practice Address - Street 1:4411 FREMONT AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103
Practice Address - Country:US
Practice Address - Phone:206-683-4495
Practice Address - Fax:206-547-2207
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2014-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT00000929175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath