MEDICARE: TAMARA WASINGER LPN

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	164W00000X	Licensed Practical Nurse	PN.0029991	CO

General Provider Information

NPI Number	:	1447741285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMARA WASINGER LPN

Provider Business Mailing Address
First Line	:	3472 RESEARCH PKWY STE 104-652
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-1066
Country	:	US
Telephone Number	:	719-494-9779
Fax Number	:

Provider Business Practice Location Address
First Line	:	3472 RESEARCH PKWY STE 104-652
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-1066
Country	:	US
Telephone Number	:	719-494-9779
Fax Number	:

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

Provider Enumeration Date	:	05/29/2018
Last Update Date	:	05/29/2018

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