Provider Demographics
NPI:1770757452
Name:MCNULTY, TANTHA LYNN (DA)
Entity type:Individual
Prefix:DR
First Name:TANTHA
Middle Name:LYNN
Last Name:MCNULTY
Suffix:
Gender:F
Credentials:DA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 FIELDSIDE DR
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-3228
Mailing Address - Country:US
Mailing Address - Phone:401-334-4053
Mailing Address - Fax:
Practice Address - Street 1:6 FIELDSIDE DR
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864-3228
Practice Address - Country:US
Practice Address - Phone:401-334-4053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDA00177171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist