Healthcare Provider Details

I. General information

NPI: 1417087404
Provider Name (Legal Business Name): TAMERA L MCCOY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 4TH STREET COURT HOUSE ANNEX
ALBANY OR
97321
US

IV. Provider business mailing address

31765 HEADGATE RD
LEBANON OR
97355-8905
US

V. Phone/Fax

Practice location:
  • Phone: 541-967-3888
  • Fax:
Mailing address:
  • Phone: 541-967-3888
  • Fax: 541-924-6911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: