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NPI Code Detail

MEDICARE: MS. TAMMY RENEE DUVAL ATC

MEDICARE: MS. TAMMY RENEE DUVAL ATC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer483NM

General Provider Information

NPI Number : 1396098950
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. TAMMY RENEE DUVAL ATC
Provider Business Mailing Address
First Line : 8408 ROCKY ACRES TRL
Second Line :
City : LAS CRUCES
State : NM
Zip : 88007
Country : US
Telephone Number : 575-644-5084
Fax Number :
Provider Business Practice Location Address
First Line : 1950 S SONOMA RANCH BLVD
Second Line :
City : LAS CRUCES
State : NM
Zip : 88011-1706
Country : US
Telephone Number : 575-527-9330
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/19/2012
Last Update Date : 10/19/2012

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Directions to “ MS. TAMMY RENEE DUVAL ATC” Practice Location

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