Healthcare Provider Details

I. General information

NPI: 1487571113
Provider Name (Legal Business Name): LISA CAROL TANNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 PIEDMONT PL
DANVILLE VA
24541-4176
US

IV. Provider business mailing address

455 GILBERT CT
DANVILLE VA
24540-5174
US

V. Phone/Fax

Practice location:
  • Phone: 434-797-3029
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number2101001769
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: