Healthcare Provider Details

I. General information

NPI: 1083743769
Provider Name (Legal Business Name): CATHERINE D TANNER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 09/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 SUMMIT ST THIRD FLOOR, SUITE 3206
OAKLAND CA
94609-3412
US

IV. Provider business mailing address

3100 SUMMIT STREET THIRD FLOOR, SUITE 3602
OAKLAND CA
94609
US

V. Phone/Fax

Practice location:
  • Phone: 510-869-6511
  • Fax: 510-869-6677
Mailing address:
  • Phone: 510-869-6500
  • Fax: 510-869-6677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number17122
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: