Individual
MARY TANKERSLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
3535 SOUTHERN BLVD, KETTERING, OH 45429-1221
(937) 395-8166
Mailing address
3131 NEWMARK DR STE 220, MIAMISBURG, OH 45342-5400
(937) 436-4658
(937) 436-4984
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
APRN.CNP.18672
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0164203
—
OH
Enumeration date
03/01/2016
Last updated
08/09/2019
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