Healthcare Provider Details

I. General information

NPI: 1851346712
Provider Name (Legal Business Name): TAMARA ANN GUCKERT R.N., B.S.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 07/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

695 VILLAGE DR
COLUMBUS OH
43214-2847
US

IV. Provider business mailing address

695 VILLAGE DR
COLUMBUS OH
43214-2847
US

V. Phone/Fax

Practice location:
  • Phone: 614-296-8074
  • Fax:
Mailing address:
  • Phone: 614-296-8074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN-138112
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: