Provider Demographics
NPI:1649501594
Name:IGNACIO, TANYA M (CNM)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:M
Last Name:IGNACIO
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1626 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-7423
Mailing Address - Country:US
Mailing Address - Phone:907-479-7701
Mailing Address - Fax:907-479-7718
Practice Address - Street 1:1626 30TH AVE
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-7423
Practice Address - Country:US
Practice Address - Phone:907-479-7701
Practice Address - Fax:907-479-7718
Is Sole Proprietor?:No
Enumeration Date:2010-01-15
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK30948163W00000X
AK1128363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No163W00000XNursing Service ProvidersRegistered Nurse