Provider Demographics
NPI:1982430765
Name:BOISVERT, TAMMY S
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:S
Last Name:BOISVERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:
Other - Last Name:FRIZELLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DOWNEAST NANNY
Mailing Address - Street 1:16 BERT GRAY RD
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:ME
Mailing Address - Zip Code:04664-3139
Mailing Address - Country:US
Mailing Address - Phone:207-294-1368
Mailing Address - Fax:
Practice Address - Street 1:16 BERT GRAY RD
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:ME
Practice Address - Zip Code:04664-3139
Practice Address - Country:US
Practice Address - Phone:207-294-1368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor