Individual
TANYA WADDLE LAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN - NP, FNP-C
Contact information
Practice address
1502 N JEFFERSON ST, CARROLLTON, MO 64633-1948
(660) 542-1695
Mailing address
1502 N JEFFERSON ST, CARROLLTON, MO 64633-1948
(660) 542-1695
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2013032494
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
420008231
—
MO
Enumeration date
09/05/2013
Last updated
12/05/2024
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