Healthcare Provider Details

I. General information

NPI: 1891933552
Provider Name (Legal Business Name): TANYA M. HOAR NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2009
Last Update Date: 05/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6226 14TH AVE
KENOSHA WI
53143-4413
US

IV. Provider business mailing address

625 57TH ST SUITE 700
KENOSHA WI
53140-4146
US

V. Phone/Fax

Practice location:
  • Phone: 262-656-0044
  • Fax:
Mailing address:
  • Phone: 262-764-3622
  • Fax: 262-925-1017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number3686-33
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number150991-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: