Healthcare Provider Details

I. General information

NPI: 1174302475
Provider Name (Legal Business Name): TANNER REUTER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2023
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 N GRANDVIEW AVE
DUBUQUE IA
52001-6388
US

IV. Provider business mailing address

350 N GRANDVIEW AVE
DUBUQUE IA
52001-6388
US

V. Phone/Fax

Practice location:
  • Phone: 563-582-1881
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number130167
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: