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General NPI Number Information
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NPI Number | 1396390845
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Entity Type | Organization
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Legal Business Name | PENNY LEAH TANNER, P.S.
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Dates
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Enumeration Date | 08/01/2019
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Last Update Date | 01/22/2026
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Provider Practice Location Address
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Address Line | 38103 MOUNTAIN HWY E
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City | EATONVILLE
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State | WA
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Zip | 98328-9202
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Country | US
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Telephone | 253-581-6106
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Fax | 360-832-6211
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Provider Business Mailing Address
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Address Line | 38103 MOUNTAIN HWY E
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City | EATONVILLE
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State | WA
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Zip | 98328-9202
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Country | US
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Telephone | 253-581-6106
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Fax | 360-832-6211
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Authorized Official
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Title or Position | P.S
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Name | PENNY L TANNER
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Credential | ARNP,PH.D.,PMHNP-BC
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Telephone | 253-581-6106
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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