=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568879666
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TAMMY VANSTOCKUM RNC, BSN, CD(DONA)
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/21/2014
-----------------------------------------------------
Last Update Date | 07/21/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2713 LINDELL AVE
-----------------------------------------------------
City | SAN ANGELO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76901-1916
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 325-262-2906
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2713 LINDELL AVE
-----------------------------------------------------
City | SAN ANGELO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76901-1916
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 325-223-9257
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374J00000X
-----------------------------------------------------
Taxonomy Name | Doula
-----------------------------------------------------
License Number | 10451
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------