Provider Demographics
NPI:1174241327
Name:WAINNER, TANYA K (MED, MA)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:K
Last Name:WAINNER
Suffix:
Gender:F
Credentials:MED, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 DRESDEN WOOD DR
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-5878
Mailing Address - Country:US
Mailing Address - Phone:210-834-7764
Mailing Address - Fax:
Practice Address - Street 1:505 DRESDEN WOOD DR
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-5878
Practice Address - Country:US
Practice Address - Phone:210-834-7764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty