Provider Demographics
NPI:1720288830
Name:MCCLENDON, TANYA A (CST)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:A
Last Name:MCCLENDON
Suffix:
Gender:F
Credentials:CST
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:A
Other - Last Name:LANER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CST
Mailing Address - Street 1:1801 N SENATE BLVD
Mailing Address - Street 2:SUITE 755
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-1228
Mailing Address - Country:US
Mailing Address - Phone:317-923-1787
Mailing Address - Fax:317-962-6259
Practice Address - Street 1:1801 N SENATE BLVD
Practice Address - Street 2:SUITE 755
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1228
Practice Address - Country:US
Practice Address - Phone:317-923-1787
Practice Address - Fax:317-962-6259
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246XC2903XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularVascular Specialist