Active NPI
Tammy Lynn Mohr
- Licensed Practical Nurse
- Grandville, MI
National Provider Identifier
1831844299
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- 305391
- Practice address
- 3584 Fairlanes Ave SW Ste 2
Grandville, MI 49418-1583 - Phone
- (616) 222-5300
- NPI assigned
- Feb 15, 2022
- Sex
- Female
- Sole proprietor
- No
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 | 305391 | WI | Primary |
Addresses
Primary practice location
3584 Fairlanes Ave SW Ste 2
Grandville, MI 49418-1583
Mailing address
3584 Fairlanes Ave SW Ste 2
Grandville, MI 49418-1583
Phone (616) 222-5300
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| M6008126391902 | Other | WI | DRIVERS LICENSE |
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 |
|---|---|---|---|
| 305391 | WI | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1644883200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1644883200000",
"number": "1831844299",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3584 FAIRLANES AVE SW STE 2",
"city": "GRANDVILLE",
"state": "MI",
"postal_code": "494181583",
"telephone_number": "616-222-5300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3584 FAIRLANES AVE SW STE 2",
"city": "GRANDVILLE",
"state": "MI",
"postal_code": "494181583",
"telephone_number": "616-222-5300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOHR",
"first_name": "TAMMY",
"middle_name": "LYNN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-02-15",
"last_updated": "2022-02-15",
"certification_date": "2022-02-15",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "WI",
"license": "305391",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DRIVERS LICENSE",
"identifier": "M6008126391902",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Grandville, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.