Individual provider · NPI-1

Tyanna Leigh Blake, R.T.(R)

Radiologic Technologist · Phoenix, AZ

NPI number1881499226
StatusActive
Last updated in NPPESFeb 18, 2025

Details

NPI
1881499226
Entity type
Individual (NPI-1)
Name
Tyanna Leigh Blake
Credential
R.T.(R)
Sex
Female
Sole proprietor
No
Enumeration date
Feb 18, 2025
Certification date
Feb 18, 2025
Last updated
Feb 18, 2025

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
247100000X Radiologic TechnologistCRT0000104107AZYes

Other names

  • Tyanna Leigh Williams (Former Name)

Practice location

650 E Indian School Rd # Rf
Phoenix, AZ 85012-1839

Phone 602-277-5551

Mailing address

10010 N 50th Ave
Glendale, AZ 85302-2419

Phone 623-826-5388

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