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General NPI Number Information
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NPI Number | 1285130997
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Entity Type | Individual
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Provider Name | TANNER HURLEY
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Gender | Male
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Dates
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Enumeration Date | 04/02/2018
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Last Update Date | 05/28/2024
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Provider Practice Location Address
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Address Line | 901 PLANTATION RD STE 3
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City | BLACKSBURG
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State | VA
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Zip | 24060-3821
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Country | US
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Telephone | 540-961-1058
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Fax | 540-961-1668
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Provider Business Mailing Address
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Address Line | 213 S JEFFERSON ST STE 1006
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City | ROANOKE
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State | VA
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Zip | 24011-1713
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VX0000X
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Taxonomy Name | Obstetrics Physician
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License Number | 0101281789
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License Number State | VA
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