| NPI | 1902310923 |
|---|---|
| Former Name | TAMMY LYNN BOTHUM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WA0400X Registered Nurse, Addiction (Substance Use Disorder) (Licence: WI 16162730) |
| Enumeration Date | 2017-11-29 |
| Last Update Date | 2017-11-29 |