MEDICARE: TANISHA RATHEY RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	942397	TX

General Provider Information

NPI Number	:	1598246977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANISHA RATHEY RN

Provider Business Mailing Address
First Line	:	8700 CROWNHILL BLVD STE 300
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-1128
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	103 LEMONWOOD DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-2408
Country	:	US
Telephone Number	:	210-665-4583
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2018
Last Update Date	:	08/24/2018

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