Provider Demographics
NPI:1962728592
Name:SMITH, TAMARA S (CDM)
Entity type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:S
Last Name:SMITH
Suffix:
Gender:F
Credentials:CDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 879548
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99687-9548
Mailing Address - Country:US
Mailing Address - Phone:907-315-3070
Mailing Address - Fax:907-373-1085
Practice Address - Street 1:545 S KNIK GOOSE BAY RD
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-8171
Practice Address - Country:US
Practice Address - Phone:907-315-3070
Practice Address - Fax:907-373-1085
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-07
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK59176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife