Provider Demographics
NPI:1457420846
Name:TAN, KIRSTEN M (RDMS,RVT)
Entity Type:Individual
Prefix:MRS
First Name:KIRSTEN
Middle Name:M
Last Name:TAN
Suffix:
Gender:F
Credentials:RDMS,RVT
Other - Prefix:
Other - First Name:CHRISTIAN
Other - Middle Name:
Other - Last Name:TAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDMS,RVT
Mailing Address - Street 1:135 NAPERVILLE DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-8394
Mailing Address - Country:US
Mailing Address - Phone:919-372-1762
Mailing Address - Fax:919-372-1762
Practice Address - Street 1:135 NAPERVILLE DR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-8394
Practice Address - Country:US
Practice Address - Phone:919-372-1762
Practice Address - Fax:919-372-1762
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD314122471V0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular Sonography