Provider Demographics
NPI:1922435627
Name:HADAWAY, TINA MICHELE (RN)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:MICHELE
Last Name:HADAWAY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3279 MT DIABLO CT APT 20
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-4040
Mailing Address - Country:US
Mailing Address - Phone:707-590-3054
Mailing Address - Fax:
Practice Address - Street 1:3279 MT DIABLO CT APT 20
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-4040
Practice Address - Country:US
Practice Address - Phone:707-590-3054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-26
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA524554163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse