Provider Demographics
NPI:1689260846
Name:ABERCROMBIA, TANAYA LYNN
Entity Type:Individual
Prefix:
First Name:TANAYA
Middle Name:LYNN
Last Name:ABERCROMBIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 17TH ST NW APT 4
Mailing Address - Street 2:
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554-1836
Mailing Address - Country:US
Mailing Address - Phone:701-319-2587
Mailing Address - Fax:
Practice Address - Street 1:502 17TH ST NW APT 4
Practice Address - Street 2:
Practice Address - City:MANDAN
Practice Address - State:ND
Practice Address - Zip Code:58554-1836
Practice Address - Country:US
Practice Address - Phone:701-319-2587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant