Provider Demographics
NPI:1730490681
Name:GHYSELS, TANYA L (NP-C)
Entity Type:Individual
Prefix:MS
First Name:TANYA
Middle Name:L
Last Name:GHYSELS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 SHEDBORNE AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45403-3143
Mailing Address - Country:US
Mailing Address - Phone:937-305-5578
Mailing Address - Fax:
Practice Address - Street 1:6438 WILMINGTON PIKE
Practice Address - Street 2:SUITE 110
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-7010
Practice Address - Country:US
Practice Address - Phone:937-848-4121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-25
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.11526-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily