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NPI Code Detail

MEDICARE: DANITA TANNER LMSW

MEDICARE: DANITA TANNER LMSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial WorkerM-08229NM

General Provider Information

NPI Number : 1477639474
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANITA TANNER LMSW
Provider Business Mailing Address
First Line : 538 N PASEO DE ONATE
Second Line : P.O. BOX 158
City : ESPANOLA
State : NM
Zip : 87532-2618
Country : US
Telephone Number : 505-753-7218
Fax Number : 505-753-5815
Provider Business Practice Location Address
First Line : 1235 EIGHTH ST.
Second Line : EL CENTRO FAMILY HEALTH LAS VEGAS CLINIC
City : LAS VEGAS
State : NM
Zip : 87701-4219
Country : US
Telephone Number : 505-425-6788
Fax Number : 505-425-5408
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/31/2006
Last Update Date : 07/09/2013

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Directions to “ DANITA TANNER LMSW” Practice Location

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