Basic Information
| Provider Information | |||||||||
| NPI: | 1881201234 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WASHINGTON | ||||||||
| FirstName: | TAMARA | ||||||||
| MiddleName: | GENEAN | ||||||||
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| Credential: | CNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5020 ALTA DR | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891073940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7026853418 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3953 YELLOW MANDARIN AVE | ||||||||
| Address2: | |||||||||
| City: | NORTH LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890814019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7025413144 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2020 | ||||||||
| LastUpdateDate: | 09/29/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3747A0650X | Y | Nursing Service Related Providers | Technician | Attendant Care Provider |
No ID Information.