Healthcare Provider Details

I. General information

NPI: 1306504311
Provider Name (Legal Business Name): NATASHA N TANNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2021
Last Update Date: 12/07/2021
Certification Date: 12/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 E ST NE
BRAINERD MN
56401-2857
US

IV. Provider business mailing address

716 E ST NE
BRAINERD MN
56401-2857
US

V. Phone/Fax

Practice location:
  • Phone: 218-828-7379
  • Fax: 218-828-7390
Mailing address:
  • Phone: 218-828-7379
  • Fax: 218-828-7390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number25647
License Number StateMN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: