Basic Information
| Provider Information | |||||||||
| NPI: | 1881618759 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FARNHAM | ||||||||
| FirstName: | TAMMY | ||||||||
| MiddleName: | LYNE | ||||||||
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| Credential: | MIDWIFE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 82 HOLLAND ST | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146052131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5854232800 | ||||||||
| FaxNumber: | 5854230739 | ||||||||
| Practice Location | |||||||||
| Address1: | 82 HOLLAND ST | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146052131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5854232800 | ||||||||
| FaxNumber: | 5854230739 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2006 | ||||||||
| LastUpdateDate: | 02/01/2011 | ||||||||
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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 | 367A00000X | 001119 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 142525CQ | 01 | NY | PREFERRED CARE | OTHER | 6613 | 01 | NY | BLUE CROSS ROCHESTER GRP | OTHER | P010101119 | 01 | NY | BLUE CHOICE ROCHESTER | OTHER | 001119 | 05 | NY | MEDICAID |