Provider Demographics
NPI:1831229400
Name:BIRD, TAMERA SUE
Entity type:Individual
Prefix:MRS
First Name:TAMERA
Middle Name:SUE
Last Name:BIRD
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:TAMERA
Other - Middle Name:SUE
Other - Last Name:ROLLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:513 TIMBERLANE AVE
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-4139
Mailing Address - Country:US
Mailing Address - Phone:931-455-9369
Mailing Address - Fax:931-455-4827
Practice Address - Street 1:615 WILSON AVE
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-3264
Practice Address - Country:US
Practice Address - Phone:931-455-9369
Practice Address - Fax:931-455-4827
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide