Provider Demographics
NPI:1609281716
Name:ROMANISHIN, TATYANA TANYA
Entity Type:Individual
Prefix:MRS
First Name:TATYANA
Middle Name:TANYA
Last Name:ROMANISHIN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:TANYA
Other - Middle Name:R
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3594 OLD COUNTRY CT
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-5980
Mailing Address - Country:US
Mailing Address - Phone:916-765-4208
Mailing Address - Fax:916-677-2262
Practice Address - Street 1:1420 E ROSEVILLE PKWY STE 140-130
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3078
Practice Address - Country:US
Practice Address - Phone:916-765-4208
Practice Address - Fax:916-677-2262
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-26
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide