Most Relevant Information
Provider Data
NPI Number: | 1003465865 |
Provider Name: | TANYA WILLARD NURSE PRACTITIONER |
Entity Type: | Individual |
Taxonomy Code: | 363LF0000X |
Specialty: | Nurse Practitioner |
License Number: | F08191103 |
Most Important Dates
Enumeration Date: | 09/05/2019 |
Last Updated: | 10/19/2023 |
Provider Practice Location
1970 ROANOKE BLVD
SALEM
VA
241536404
Practice Location Phone/Fax
Phone: | 5409822463 |
Fax: |
Provider Mailing Location
5218 GREEN MEADOW RD
ROANOKE
VA
240183304
Provider Mailing Phone/Fax
Phone: | 5403097931 |
Fax: |