Provider Demographics
NPI:1518197078
Name:HATFIELD, TANYA LANE (IDMT)
Entity Type:Individual
Prefix:MISS
First Name:TANYA
Middle Name:LANE
Last Name:HATFIELD
Suffix:
Gender:F
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 GRIER DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-3704
Mailing Address - Country:US
Mailing Address - Phone:800-799-0526
Mailing Address - Fax:
Practice Address - Street 1:811 GRIER DR
Practice Address - Street 2:SUITE B
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-3704
Practice Address - Country:US
Practice Address - Phone:800-799-0526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-19
Last Update Date:2009-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians