Provider Demographics
NPI:1013685171
Name:LADER, TANYA MARY
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:MARY
Last Name:LADER
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 1:4109 KINNEY GULF RD
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-9181
Mailing Address - Country:US
Mailing Address - Phone:607-591-4590
Mailing Address - Fax:
Practice Address - Street 1:4109 KINNEY GULF RD
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-9181
Practice Address - Country:US
Practice Address - Phone:607-591-4590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider