Provider Demographics
NPI:1861987026
Name:TATUM, SHERINA JOY (CPM)
Entity type:Individual
Prefix:
First Name:SHERINA
Middle Name:JOY
Last Name:TATUM
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75-5851 KUAKINI HWY # 291291
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-2199
Mailing Address - Country:US
Mailing Address - Phone:808-378-8846
Mailing Address - Fax:
Practice Address - Street 1:75-5851 KUAKINI HWY # 291291
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-2199
Practice Address - Country:US
Practice Address - Phone:808-378-8846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM11030032176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife