Provider Demographics
NPI:1891258182
Name:DEMEAN, TAMARA DAWN (NP-C)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:DAWN
Last Name:DEMEAN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 G ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-1964
Mailing Address - Country:US
Mailing Address - Phone:208-743-9616
Mailing Address - Fax:833-963-2105
Practice Address - Street 1:1331 G ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-1964
Practice Address - Country:US
Practice Address - Phone:208-743-9616
Practice Address - Fax:833-963-2105
Is Sole Proprietor?:No
Enumeration Date:2019-04-12
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID61172363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2136938Medicaid