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NPI Code Detail

MEDICARE: TANYA NEELY

MEDICARE: TANYA NEELY
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
1163WC0200XCritical Care Medicine Registered Nurse60137227WA
2363LF0000XFamily Nurse PractitionerAP61127888WA

General Provider Information

NPI Number : 1760008908
Entity Type Code : Individual
Provider Name (Legal Business Name) : TANYA NEELY
Provider Business Mailing Address
First Line : 131 MCKALL CT
Second Line :
City : KELSO
State : WA
Zip : 98626-2256
Country : US
Telephone Number : 360-749-9120
Fax Number : 855-790-9134
Provider Business Practice Location Address
First Line : 4550 KRUSE WAY STE 125
Second Line :
City : LAKE OSWEGO
State : OR
Zip : 97035-3533
Country : US
Telephone Number : 503-369-3135
Fax Number : 855-790-9134
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2020
Last Update Date : 05/27/2025

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Directions to “ TANYA NEELY ” Practice Location

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