Healthcare Provider Details

I. General information

NPI: 1588920953
Provider Name (Legal Business Name): TAMMY STEWART LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAMMY COOKE LPN

II. Dates (important events)

Enumeration Date: 04/10/2012
Last Update Date: 11/12/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 WOLF RD SUITE 100A
ALBANY NY
12205-6007
US

IV. Provider business mailing address

79 NEW SCOTLAND ROAD
ALBANY NY
12047
US

V. Phone/Fax

Practice location:
  • Phone: 518-437-0152
  • Fax: 518-437-0269
Mailing address:
  • Phone: 518-549-2500
  • Fax: 518-549-6534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number303040-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: