Provider Demographics
NPI:1902542293
Name:TANNAHILL, GINY NACOLE
Entity Type:Individual
Prefix:
First Name:GINY
Middle Name:NACOLE
Last Name:TANNAHILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6901 E LAKE MEAD BLVD APT 2148
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89156-1160
Mailing Address - Country:US
Mailing Address - Phone:719-464-9815
Mailing Address - Fax:
Practice Address - Street 1:6901 E LAKE MEAD BLVD APT 2148
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89156-1160
Practice Address - Country:US
Practice Address - Phone:719-464-9815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician