Provider Demographics
NPI:1912383365
Name:MCDOW, TANYA DENISE
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:DENISE
Last Name:MCDOW
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 1:2560 TAVISTOCK CT
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-7111
Mailing Address - Country:US
Mailing Address - Phone:313-482-0835
Mailing Address - Fax:
Practice Address - Street 1:2560 TAVISTOCK CT
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-7111
Practice Address - Country:US
Practice Address - Phone:313-482-0835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-08
Last Update Date:2015-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider