MEDICARE: TAMI KANNING L.E.

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
1	174400000X	Specialist	BAP-E-10154011	OR

General Provider Information

NPI Number	:	1538528377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMI KANNING L.E.

Provider Business Mailing Address
First Line	:	3575 DONALD ST STE 630
Second Line	:
City	:	EUGENE
State	:	OR
Zip	:	97405-4775
Country	:	US
Telephone Number	:	541-514-4857
Fax Number	:

Provider Business Practice Location Address
First Line	:	3575 DONALD ST STE 630
Second Line	:
City	:	EUGENE
State	:	OR
Zip	:	97405-4775
Country	:	US
Telephone Number	:	541-514-4857
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2016
Last Update Date	:	02/22/2016

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Directions to “ TAMI KANNING L.E.” Practice Location

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