1710986187 NPI number — TAMMY S WALBERT FNP-BC

Table of content: TAMMY S WALBERT FNP-BC (NPI 1710986187)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710986187 NPI number — TAMMY S WALBERT FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALBERT
Provider First Name:
TAMMY
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CAHALL
Provider Other First Name:
TAMMY
Provider Other Middle Name:
S
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
FNP-BC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1710986187
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/27/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 E CARROLL ST
Provider Second Line Business Mailing Address:
ATTN: PRMG
Provider Business Mailing Address City Name:
SALISBURY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21801-5422
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-543-7531
Provider Business Mailing Address Fax Number:
410-912-6386

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
145 E CARROLL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALISBURY
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-539-1026
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/19/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  LG-0000356 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: R110410 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 409710600 . This is a "MEDICAID MARYLAND" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1184832040 . This is a "GROUP NPI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1000036982 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".




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