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General NPI Number Information
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NPI Number | 1902587405
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Entity Type | Individual
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Provider Name | TAMMY LYNN UNDERWOOD FNP-C
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Gender | Female
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Dates
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Enumeration Date | 07/27/2023
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Last Update Date | 07/27/2023
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Provider Practice Location Address
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Address Line | 1263 ROUTE 40 W
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City | CLAYSVILLE
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State | PA
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Zip | 15323-1277
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Country | US
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Telephone | 724-663-7731
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Fax |
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Provider Business Mailing Address
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Address Line | 144 STONEGATE DR
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City | CANONSBURG
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State | PA
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Zip | 15317-2765
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Country | US
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Telephone | 412-848-0356
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | SP027909
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License Number State | PA
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