Provider Demographics
NPI:1558782375
Name:TANYI, CONRAD KUMBELLA
Entity Type:Individual
Prefix:
First Name:CONRAD
Middle Name:KUMBELLA
Last Name:TANYI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1280 TERMINAL WAY
Mailing Address - Street 2:STE #5
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-3219
Mailing Address - Country:US
Mailing Address - Phone:775-322-0669
Mailing Address - Fax:775-424-2888
Practice Address - Street 1:1280 TERMINAL WAY
Practice Address - Street 2:STE #5
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-3219
Practice Address - Country:US
Practice Address - Phone:775-322-0669
Practice Address - Fax:775-424-2888
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-20
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker