Provider Demographics
NPI:1881300739
Name:PROCTOR, TYANNA
Entity type:Individual
Prefix:
First Name:TYANNA
Middle Name:
Last Name:PROCTOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 UPPER ROCK CIR APT 124
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-4460
Mailing Address - Country:US
Mailing Address - Phone:202-595-4842
Mailing Address - Fax:
Practice Address - Street 1:1100 EASTERN AVE NE APT PH4
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-4036
Practice Address - Country:US
Practice Address - Phone:202-609-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion