Individual
TATYANA ANATOLIA OMDAHL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
13920 SAGEBROOK RD, MIDLOTHIAN, VA 23112-4228
(434) 247-1481
Mailing address
13920 SAGEBROOK RD, MIDLOTHIAN, VA 23112-4228
(434) 247-1481
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
2305204078
VA
Other
Enumeration date
08/29/2012
Last updated
08/29/2012
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