Basic Information
| Provider Information | |||||||||
| NPI: | 1124646401 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BEARD | ||||||||
| FirstName: | TAMMI | ||||||||
| MiddleName: | |||||||||
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| Credential: | CRM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1435 NE 4TH ST STE B | ||||||||
| Address2: | |||||||||
| City: | BEND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977014268 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417777847 | ||||||||
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| Practice Location | |||||||||
| Address1: | 125 SW C ST | ||||||||
| Address2: | |||||||||
| City: | MADRAS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977411458 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413064556 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2020 | ||||||||
| LastUpdateDate: | 07/13/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 175T00000X | 202-CRM-163 | OR | Y |
No ID Information.