Tammy Jo Dayley

Individual provider Active NPI Technician/Technologist · Gooding, ID

NPI 1083117402 · NPPES record last updated Mar 12, 2018

Key facts

NPI
1083117402
Entity type
Individual (NPI type 1)
Primary specialty
Technician/Technologist 156F00000X
Practice address
267 N Canyon Dr
Gooding, ID 83330-5500
Phone
(208) 934-4446
Fax
(208) 934-4442
NPI assigned
Mar 12, 2018
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Technician/Technologist 156F00000X Yes

Addresses

Primary practice location

267 N Canyon Dr
Gooding, ID 83330-5500

Mailing address

267 N Canyon Dr
Gooding, ID 83330-5500
Phone (208) 934-4446

Other identifiers

IdentifierTypeStateIssuer
1370131OtherIDMEDICARE PART B

Other providers in Gooding, ID

All providers in Gooding, ID · Technician/Technologist in Idaho

Sources for this page

Verify at the official NPI Registry.