Provider Demographics
NPI:1083090377
Name:POLES/ATTAHER, TANETTA
Entity Type:Individual
Prefix:
First Name:TANETTA
Middle Name:
Last Name:POLES/ATTAHER
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 1:5504 WESTFORD RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19120-2642
Mailing Address - Country:US
Mailing Address - Phone:610-209-2731
Mailing Address - Fax:
Practice Address - Street 1:5504 WESTFORD RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19120-2642
Practice Address - Country:US
Practice Address - Phone:610-209-2731
Practice Address - Fax:610-314-0960
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-10
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA374U00000X
PA95627982251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No374U00000XNursing Service Related ProvidersHome Health Aide