Active NPI
Tammy Sue Wilburn, LPN
- Licensed Practical Nurse
- Waverly, OH
National Provider Identifier
1750477675
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- PN113571
- Practice address
- 4408 Clines Chapel Rd
Waverly, OH 45690-8925 - Phone
- (740) 835-8273
- NPI assigned
- Oct 5, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | PN113571 | OH | Primary |
Addresses
Primary practice location
4408 Clines Chapel Rd
Waverly, OH 45690-8925
Mailing address
4408 Clines Chapel Rd
Waverly, OH 45690-8925
Phone (740) 835-8273
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PN113571 | OH | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160006400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1212969600000",
"number": "1750477675",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4408 CLINES CHAPEL RD",
"city": "WAVERLY",
"state": "OH",
"postal_code": "456908925",
"telephone_number": "740-835-8273"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4408 CLINES CHAPEL RD",
"city": "WAVERLY",
"state": "OH",
"postal_code": "456908925",
"telephone_number": "740-835-8273"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILBURN",
"first_name": "TAMMY",
"middle_name": "SUE",
"credential": "LPN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-10-05",
"last_updated": "2008-06-09",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "OH",
"license": "PN113571",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waverly, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.