Provider Demographics
NPI:1942971486
Name:REID, TANYA (LPN)
Entity Type:Individual
Prefix:MS
First Name:TANYA
Middle Name:
Last Name:REID
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16507A NORTHCROSS DR STE 108
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-5081
Mailing Address - Country:US
Mailing Address - Phone:980-585-6531
Mailing Address - Fax:
Practice Address - Street 1:16507A NORTHCROSS DR STE 108
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-5081
Practice Address - Country:US
Practice Address - Phone:980-585-6531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-24
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC66313164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse