Provider Demographics
NPI:1871345678
Name:VAN GORDER, TANYA D (LPN)
Entity type:Individual
Prefix:MS
First Name:TANYA
Middle Name:D
Last Name:VAN GORDER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:TANYA
Other - Middle Name:D
Other - Last Name:PASSWATERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:515 ANDREWS LAKE RD
Mailing Address - Street 2:
Mailing Address - City:FELTON
Mailing Address - State:DE
Mailing Address - Zip Code:19943-4648
Mailing Address - Country:US
Mailing Address - Phone:302-943-8276
Mailing Address - Fax:
Practice Address - Street 1:515 ANDREWS LAKE RD
Practice Address - Street 2:
Practice Address - City:FELTON
Practice Address - State:DE
Practice Address - Zip Code:19943-4648
Practice Address - Country:US
Practice Address - Phone:302-943-8276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL2-0010798164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse