Provider Demographics
NPI:1871828541
Name:REDD, TAWNY RACHEL (APRN)
Entity Type:Individual
Prefix:
First Name:TAWNY
Middle Name:RACHEL
Last Name:REDD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:TAWNY
Other - Middle Name:RACHEL
Other - Last Name:THORNTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:2601 E ROOSEVELT ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-4973
Mailing Address - Country:US
Mailing Address - Phone:602-344-5890
Mailing Address - Fax:602-344-5932
Practice Address - Street 1:2601 E ROOSEVELT ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-4973
Practice Address - Country:US
Practice Address - Phone:602-344-5890
Practice Address - Fax:602-344-5932
Is Sole Proprietor?:No
Enumeration Date:2009-10-13
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5207414-4405363LN0000X
AZAP5231363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal