Healthcare Provider Details

I. General information

NPI: 1437008141
Provider Name (Legal Business Name): TAMMY LYNNE VANWARMERDAM RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2026
Last Update Date: 01/26/2026
Certification Date: 01/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6767 GREEN VALLEY RD
PLACERVILLE CA
95667-8984
US

IV. Provider business mailing address

6620 PROVIDENCE HILL RD
GARDEN VALLEY CA
95633-9770
US

V. Phone/Fax

Practice location:
  • Phone: 530-295-2265
  • Fax: 530-621-1397
Mailing address:
  • Phone: 208-697-1877
  • Fax: 530-621-1397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number612381
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number612381
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: