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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

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