Individual
GAYLEN Q TASSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
12340 BERMUDA CROSSROAD LN, CHESTER, VA 23831-2352
(804) 287-4550
(804) 717-8292
Mailing address
12340 BERMUDA CROSSROAD LN, CHESTER, VA 23831-2352
(804) 287-4550
(804) 717-8292
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
0024164429
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C09633
GROUP PTAN
VA
Enumeration date
09/29/2014
Last updated
09/29/2014
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