MEDICARE: MS. TAMMY M. DAUGHERTY MSN, CNM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367A00000X	Advanced Practice Midwife	APRN.CNM.00180	OH

General Provider Information

NPI Number	:	1285626556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TAMMY M. DAUGHERTY MSN, CNM

Provider Business Mailing Address
First Line	:	819 SOUTHWESTERN RUN
Second Line	:	UNIT 1
City	:	POLAND
State	:	OH
Zip	:	44514-3688
Country	:	US
Telephone Number	:	330-629-9991
Fax Number	:	330-629-9992

Provider Business Practice Location Address
First Line	:	8423 MARKET ST FL 3
Second Line	:
City	:	BOARDMAN
State	:	OH
Zip	:	44512-6778
Country	:	US
Telephone Number	:	330-729-7901
Fax Number	:	330-729-7915

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	10/28/2024

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