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NPI Code Detail

MEDICARE: TAMMY MICHELLE PRATER RN

MEDICARE: TAMMY MICHELLE PRATER RN
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
1163WG0600XGerontology Registered Nurse041306578IL

General Provider Information

NPI Number : 1497429575
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAMMY MICHELLE PRATER RN
Provider Business Mailing Address
First Line : 3450 SARATOGA AVE
Second Line :
City : DOWNERS GROVE
State : IL
Zip : 60515-1141
Country : US
Telephone Number : 630-962-1528
Fax Number :
Provider Business Practice Location Address
First Line : 3450 SARATOGA AVE
Second Line :
City : DOWNERS GROVE
State : IL
Zip : 60515-1141
Country : US
Telephone Number : 630-962-1528
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2021
Last Update Date : 08/03/2021

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