Provider Demographics
NPI:1770298325
Name:LANIER, TATYAUNA (FNP-C)
Entity type:Individual
Prefix:MS
First Name:TATYAUNA
Middle Name:
Last Name:LANIER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 ALDERSHOT RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-2110
Mailing Address - Country:US
Mailing Address - Phone:410-329-0159
Mailing Address - Fax:
Practice Address - Street 1:650 MCHENRY RD
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:MD
Practice Address - Zip Code:21001-2607
Practice Address - Country:US
Practice Address - Phone:443-843-6262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR219260207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine