| NPI | 1245506484 |
|---|---|
| Former Name | TAMARA LEE PROCHNOW |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WA0400X Registered Nurse, Addiction (Substance Use Disorder) (Licence: OR 200843129RN) |
| Enumeration Date | 2012-03-30 |
| Last Update Date | 2012-04-20 |