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General NPI Number Information
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NPI Number | 1881300739
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Entity Type | Individual
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Provider Name | TYANNA PROCTOR
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Gender | Female
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Dates
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Enumeration Date | 01/24/2023
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Last Update Date | 01/24/2023
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Provider Practice Location Address
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Address Line | 1100 EASTERN AVE NE APT PH4
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City | WASHINGTON
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State | DC
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Zip | 20019-4036
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Country | US
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Telephone | 202-609-2500
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Fax |
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Provider Business Mailing Address
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Address Line | 30 UPPER ROCK CIR APT 124
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City | ROCKVILLE
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State | MD
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Zip | 20850-4460
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Country | US
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Telephone | 202-595-4842
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number |
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License Number State |
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