MEDICARE: TAMMY JO TOMS

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
1	163WM0705X	Medical-Surgical Registered Nurse	041436592	IL
2	163WP0808X	Psychiatric/Mental Health Registered Nurse	041436592	IL
3	163W00000X	Registered Nurse	041436592	IL

General Provider Information

NPI Number	:	1447039110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMMY JO TOMS

Provider Business Mailing Address
First Line	:	13353 JORDAN CREEK RD
Second Line	:
City	:	EWING
State	:	IL
Zip	:	62836-1240
Country	:	US
Telephone Number	:	618-927-9340
Fax Number	:

Provider Business Practice Location Address
First Line	:	13353 JORDAN CREEK RD
Second Line	:
City	:	EWING
State	:	IL
Zip	:	62836-1240
Country	:	US
Telephone Number	:	618-927-9340
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2023
Last Update Date	:	09/22/2023

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Directions to “ TAMMY JO TOMS ” Practice Location

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