Basic Information
| Provider Information | |||||||||
| NPI: | 1760644082 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HANKE | ||||||||
| FirstName: | TANYA | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 WAYMAN LN | ||||||||
| Address2: | |||||||||
| City: | BAR HARBOR | ||||||||
| State: | ME | ||||||||
| PostalCode: | 046091625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2072885081 | ||||||||
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| Practice Location | |||||||||
| Address1: | 16 COMMUNITY LN | ||||||||
| Address2: | |||||||||
| City: | SOUTHWEST HARBOR | ||||||||
| State: | ME | ||||||||
| PostalCode: | 046794273 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2072856324 | ||||||||
| FaxNumber: | 2072444418 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2008 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 51121 | CT | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1760644082 | 05 | ME | MEDICAID | DO2318 | 01 | ME | MAINE LICENSE | OTHER |