MEDICARE: TAMERA DAVIES FUHRER 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	305369-031	WI

General Provider Information

NPI Number	:	1659668739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMERA DAVIES FUHRER LPN

Provider Business Mailing Address
First Line	:	303 W DEAN AVE
Second Line	:
City	:	MONONA
State	:	WI
Zip	:	53716-1009
Country	:	US
Telephone Number	:	608-843-0456
Fax Number	:

Provider Business Practice Location Address
First Line	:	4413 AMERICAN ASH DR
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53704-1169
Country	:	US
Telephone Number	:	608-334-8011
Fax Number	:

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

Provider Enumeration Date	:	07/08/2011
Last Update Date	:	07/08/2011

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