Provider Demographics
NPI:1992023956
Name:BASS, TANGELA LEE (ACUPUNCTURIST)
Entity Type:Individual
Prefix:
First Name:TANGELA
Middle Name:LEE
Last Name:BASS
Suffix:
Gender:F
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8013 HEAVENLY VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23231-8955
Mailing Address - Country:US
Mailing Address - Phone:804-651-0445
Mailing Address - Fax:
Practice Address - Street 1:8013 HEAVENLY VALLEY DR
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23231-8955
Practice Address - Country:US
Practice Address - Phone:804-651-0445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-13
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000575171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist