Provider Demographics
NPI:1710403233
Name:DOVE, TANYA
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:DOVE
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 1:10095 GREEN BAY RD
Mailing Address - Street 2:
Mailing Address - City:RICE
Mailing Address - State:VA
Mailing Address - Zip Code:23966-2413
Mailing Address - Country:US
Mailing Address - Phone:434-414-4701
Mailing Address - Fax:
Practice Address - Street 1:10095 GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:RICE
Practice Address - State:VA
Practice Address - Zip Code:23966-2413
Practice Address - Country:US
Practice Address - Phone:434-414-4701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver