Individual
TANYA MICHELLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAC RN HTP CST M.OM.
Contact information
Practice address
10304 N HAYDEN RD, SCOTTSDALE, AZ 85258-1217
(612) 888-3666
Mailing address
555 N COLLEGE AVE APT 2072, TEMPE, AZ 85281-0193
(612) 888-6666
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
239494
AZ
163W00000X
Registered Nurse
R 121581-0
MN
171100000X
Acupuncturist
1834
MN
171100000X
Acupuncturist
Primary
LAC-010140
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4841294
STATE TAX ID #
MN
01
—
621399
NAICS
MN
Enumeration date
01/23/2017
Last updated
10/30/2020
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