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Ms. Tammy Lark Honold
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NPI Number Detailed Information
Provider Information:
| Name: | Ms. Tammy Lark Honold |
| Gender: | F |
| Provider License Number If Given: | 201905 |
NPI Information:
| NPI: | 1033103544 |
| Entity Type (Individual or Organization): |
1-ind |
| Enumeration Date: | 9/12/2005 |
| Last Update Date: | 7/8/2007 |
Provider Business Mailing Address:
| Address: | 680 SAGEWOOD DR Ignacio, CO 81137 |
| Phone Number: | 9705634581 |
| Fax Number: | 9705630206 |
Provider Business Practice Location Address:
| Address: | 123 HWY 172 Ignacio, CO 81137 |
| Phone Number: | 9705634581 |
| Fax Number: | 9705630206 |
Provider Taxonomy:
| Primary: | 124Q00000X |
| Secondary (if any): | |
| State: | CO |
