| Doctor Name: | TAMARA LYNN HERBENER-KALLAL |
| NPI Number: | 1174587216 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP-BC |
| License Number: | APN.002007-NP |
| Business Practice Address: | 501 Airport Rd Rifle, CO - 816508510 |
| Business Phone Number: | 9706256487 |
| Business Fax Number: | |
| Mailing Address: | 501 Airport Rd, RIFLE |
| State: | CO |
| Postal Code: | 816508510 |
| Phone Number: | 9706256487 |
| Fax Number: | |
| NPI Enumeration Date: | 04/14/2006 |
| NPI Last Update Date: | 05/13/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP2300X |
| License Number: | APN.002007-NP |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |