Basic Information
| Provider Information | |||||||||
| NPI: | 1760711485 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAM | ||||||||
| FirstName: | LUANN | ||||||||
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| OtherLastName: | TAM | ||||||||
| OtherFirstName: | LUANN | ||||||||
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| OtherCredential: | CNM, NP | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 185 S MOUNTAIN TRL | ||||||||
| Address2: | |||||||||
| City: | SIERRA MADRE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 910242660 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6268629788 | ||||||||
| FaxNumber: | 6263550127 | ||||||||
| Practice Location | |||||||||
| Address1: | 1420 S CENTRAL AVE | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 912042508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8185021900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2009 | ||||||||
| LastUpdateDate: | 12/06/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 2367 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 367A00000X | 512 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
No ID Information.