| NPI | 1376775163 |
|---|---|
| Former Name | ALICIA RENEE TANNER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NC 5004393) |
| Additional Taxonomies | 207RH0003X Internal Medicine, Hematology & Oncology (Licence: NC 5004393) |
| 207RH0003X Internal Medicine, Hematology & Oncology (Licence: NC 230635) | |
| Enumeration Date | 2009-08-13 |
| Last Update Date | 2013-08-07 |