Healthcare Provider Details

I. General information

NPI: 1558803866
Provider Name (Legal Business Name): TAWANA JAMES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2016
Last Update Date: 01/19/2021
Certification Date: 01/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 S MAIN ST
HANOVER NH
03755-2066
US

IV. Provider business mailing address

PO BOX 762
HANOVER NH
03755-0762
US

V. Phone/Fax

Practice location:
  • Phone: 973-214-7017
  • Fax:
Mailing address:
  • Phone: 973-214-7017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: