Provider Demographics
NPI:1992372767
Name:DAWSON, TANISHA DANAE
Entity Type:Individual
Prefix:
First Name:TANISHA
Middle Name:DANAE
Last Name:DAWSON
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 1:1500 CHESTNUT ST STE 1694
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-2737
Mailing Address - Country:US
Mailing Address - Phone:215-954-7041
Mailing Address - Fax:856-629-0837
Practice Address - Street 1:4513 LUDLOW ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139-3640
Practice Address - Country:US
Practice Address - Phone:215-954-7041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide