Healthcare Provider Details

I. General information

NPI: 1255483772
Provider Name (Legal Business Name): TAMARA K CANTERBURY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 08/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2537 EISENHOWER RD
OTTAWA KS
66067-9482
US

IV. Provider business mailing address

PO BOX 677
OTTAWA KS
66067-0677
US

V. Phone/Fax

Practice location:
  • Phone: 785-242-3780
  • Fax: 785-242-6397
Mailing address:
  • Phone: 785-242-3780
  • Fax: 785-242-6397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberAPRN 53-74343-091
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: