Healthcare Provider Details

I. General information

NPI: 1679477111
Provider Name (Legal Business Name): TAMARA WEBSTER DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 E ADAMS ST
SYRACUSE NY
13210-2306
US

IV. Provider business mailing address

9942A SARATOGA RD
FORT DRUM NY
13603-3409
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-5540
  • Fax:
Mailing address:
  • Phone: 310-480-4199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberN52414
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: