| NPI | 1518371756 |
|---|---|
| Former Name | STEPHANIE LEIGH TANNER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA MD462124) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NJ 25MA10143800) |
| 208000000X Pediatrics (Licence: DE C1-0012210) | |
| Enumeration Date | 2014-06-16 |
| Last Update Date | 2018-03-17 |