Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0401X | Family Doctor - Addiction Medicine | 0024182739 | VA |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 0024182739 | VA |
NPI | 1164193702 |
---|---|
Provider Name | Tanya Lyte |
First Address | Rixeyville, VA 22737-2005 |
Second Address | Manassas, VA 20110-4414 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2021 |
Last Update Date | 09/12/2021 |