Doctor Name: | JANINE TANNER |
NPI Number: | 1417183823 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | APN |
License Number: | 209007562 |
Business Practice Address: | 3351 W Main Street St. Charles, IL - 60175 |
Business Phone Number: | 8668253227 |
Business Fax Number: | |
Mailing Address: | 161 Washington Street 14th Floor, Eight Tower Bridge, Suite 1400 CONSHOHOCKEN |
State: | PA |
Postal Code: | 19428 |
Phone Number: | 8668253227 |
Fax Number: | |
NPI Enumeration Date: | 06/01/2009 |
NPI Last Update Date: | 06/01/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 209007562 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |