| NPI | 1700123064 |
|---|---|
| Doing Business As | ELLAD PREVENTATIVE HEALTH SERVICES |
| Entity Type | Organization |
| Authorized Contact | TYRA L TANNER Clinical Director 804-616-4378 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 133V00000X Dietitian, Registered |
| 261QH0100X Clinic/Center, Health Services | |
| 363L00000X Nurse Practitioner | |
| 363LA2200X Nurse Practitioner, Adult Health | |
| 364S00000X Clinical Nurse Specialist | |
| Enumeration Date | 2013-01-07 |
| Last Update Date | 2023-02-27 |