Provider Demographics
NPI:1053557868
Name:HALFORD, TAMARA LEA (LPN)
Entity type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:LEA
Last Name:HALFORD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 PETTIS RD
Mailing Address - Street 2:
Mailing Address - City:GANSEVOORT
Mailing Address - State:NY
Mailing Address - Zip Code:12831-2216
Mailing Address - Country:US
Mailing Address - Phone:518-584-5614
Mailing Address - Fax:
Practice Address - Street 1:300 PETTIS RD
Practice Address - Street 2:
Practice Address - City:GANSEVOORT
Practice Address - State:NY
Practice Address - Zip Code:12831-2216
Practice Address - Country:US
Practice Address - Phone:518-584-5614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-29
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY267466164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse