Provider Demographics
NPI:1265036149
Name:TANKERSLEY, ELAINE (RDH, OMT)
Entity Type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:
Last Name:TANKERSLEY
Suffix:
Gender:F
Credentials:RDH, OMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2903 MERRYWEATHER CT
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-4405
Mailing Address - Country:US
Mailing Address - Phone:704-953-7828
Mailing Address - Fax:
Practice Address - Street 1:250 BRANCHVIEW DR NE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-3415
Practice Address - Country:US
Practice Address - Phone:980-349-8104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC07628174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist