| NPI | 1841634227 |
|---|---|
| Former Name | JILLIAN A TANNER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CT 6540) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MA 2274068) |
| Enumeration Date | 2013-04-29 |
| Last Update Date | 2018-03-17 |