Healthcare Provider Details

I. General information

NPI: 1366899593
Provider Name (Legal Business Name): TAMARA LEE GOLDEN HNB-BC, WHE, NBC-HWC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2016
Last Update Date: 07/20/2021
Certification Date: 07/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

276 MAIN ST
CHARLESTOWN NH
03603-4908
US

IV. Provider business mailing address

PO BOX 222
CHARLESTOWN NH
03603-0222
US

V. Phone/Fax

Practice location:
  • Phone: 603-826-4955
  • Fax:
Mailing address:
  • Phone: 802-234-1037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number034185-21
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: