Provider Demographics
NPI:1962610964
Name:ALEXANDER, TAMARA LYNN
Entity type:Individual
Prefix:MS
First Name:TAMARA
Middle Name:LYNN
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3321 SUMMER GLEN DR
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-9344
Mailing Address - Country:US
Mailing Address - Phone:614-539-3629
Mailing Address - Fax:
Practice Address - Street 1:3321 SUMMER GLEN DR
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-9344
Practice Address - Country:US
Practice Address - Phone:614-539-3629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2247392372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider