Provider Demographics
NPI:1073190054
Name:TELLO, NANCY LIZBETH
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:LIZBETH
Last Name:TELLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 S 34TH AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-4805
Mailing Address - Country:US
Mailing Address - Phone:509-910-9291
Mailing Address - Fax:
Practice Address - Street 1:1310 S 34TH AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-4805
Practice Address - Country:US
Practice Address - Phone:509-910-9291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC13697171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter