Provider Demographics
NPI:1104389758
Name:SALMON, TANYA JO
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:JO
Last Name:SALMON
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:PO BOX 4030
Mailing Address - Street 2:
Mailing Address - City:IGIUGIG
Mailing Address - State:AK
Mailing Address - Zip Code:99613-4030
Mailing Address - Country:US
Mailing Address - Phone:907-533-3207
Mailing Address - Fax:907-533-3225
Practice Address - Street 1:4030 HIGH RIDGE COURT
Practice Address - Street 2:
Practice Address - City:IGIUGIG
Practice Address - State:AK
Practice Address - Zip Code:99613
Practice Address - Country:US
Practice Address - Phone:907-533-3207
Practice Address - Fax:907-533-3225
Is Sole Proprietor?:No
Enumeration Date:2019-04-10
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide