Provider Demographics
NPI:1811721582
Name:GWALTNEY, TANA LEIGH (LPN)
Entity type:Individual
Prefix:
First Name:TANA
Middle Name:LEIGH
Last Name:GWALTNEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:TANA
Other - Middle Name:LEIGH
Other - Last Name:HORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:4040 MEMORIAL PKWY SW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-4364
Mailing Address - Country:US
Mailing Address - Phone:256-975-9285
Mailing Address - Fax:
Practice Address - Street 1:4040 MEMORIAL PKWY SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-4364
Practice Address - Country:US
Practice Address - Phone:256-715-6226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2-064996164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse