Individual
KYLIE TANABE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
40 PROSPECT AVE, BUILDING 2, 4C, NORWALK, CT 06850-3737
(207) 671-0235
Mailing address
24 STEVENS ST, BUILDING 2, 4C, NORWALK, CT 06850-3852
(203) 852-2188
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
3407
CT
363AS0400X
Surgical Physician Assistant
3407
CT
363AS0400X
Surgical Physician Assistant
Primary
54130
CA
Other
Enumeration date
08/26/2015
Last updated
02/24/2017
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