Healthcare Provider Details

I. General information

NPI: 1811809320
Provider Name (Legal Business Name): TANNER TOMCHUK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2310 CRAIG RD
EAU CLAIRE WI
54701-6128
US

IV. Provider business mailing address

4019 TOWNE LAKES AVE APT 4214
GRAND CHUTE WI
54913-8158
US

V. Phone/Fax

Practice location:
  • Phone: 715-858-4610
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberR50656
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: