Provider Demographics
NPI:1649473802
Name:GETCHELL, TANYA R (EMT-IT)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:R
Last Name:GETCHELL
Suffix:
Gender:F
Credentials:EMT-IT
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:R
Other - Last Name:VANDEVENTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EMT-IT
Mailing Address - Street 1:886 HARBOR RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:WI
Mailing Address - Zip Code:53563-9621
Mailing Address - Country:US
Mailing Address - Phone:608-751-2292
Mailing Address - Fax:
Practice Address - Street 1:11101 N SHERMAN RD
Practice Address - Street 2:
Practice Address - City:EDGERTON
Practice Address - State:WI
Practice Address - Zip Code:53534-9002
Practice Address - Country:US
Practice Address - Phone:608-751-2292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI36785146M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, Intermediate
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI36785OtherWI LICENSE NUMBER