Healthcare Provider Details

I. General information

NPI: 1164066080
Provider Name (Legal Business Name): TAMMY TRENAMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2019
Last Update Date: 06/17/2020
Certification Date: 06/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WYOMING ST
DAYTON OH
45409-2723
US

IV. Provider business mailing address

1 WYOMING ST
DAYTON OH
45409-2793
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-9969
  • Fax:
Mailing address:
  • Phone: 937-208-9969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.024904
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: