Provider Demographics
NPI:1770727158
Name:TANTAY, MICHAEL ANGELO (CRNA)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ANGELO
Last Name:TANTAY
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:125 NW 20TH PL UNIT NO511
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-1042
Mailing Address - Country:US
Mailing Address - Phone:714-334-4787
Mailing Address - Fax:
Practice Address - Street 1:125 NW 20TH PLACE
Practice Address - Street 2:UNIT NO 511
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-1042
Practice Address - Country:US
Practice Address - Phone:714-334-4787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-29
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3851367500000X
OR201060008367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered