| Doctor Name: | ELYSE TANNER |
| NPI Number: | 1083003230 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CPNP |
| License Number: | SP014438 |
| Business Practice Address: | 345 Main St Ste 9 Harleysville, PA - 194382420 |
| Business Phone Number: | 2152563080 |
| Business Fax Number: | |
| Mailing Address: | 345 Main St Ste 9, HARLEYSVILLE |
| State: | PA |
| Postal Code: | 194382420 |
| Phone Number: | 2152563080 |
| Fax Number: | |
| NPI Enumeration Date: | 01/12/2015 |
| NPI Last Update Date: | 01/12/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0200X |
| License Number: | SP014438 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |