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General NPI Number Information
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NPI Number | 1518919265
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Entity Type | Individual
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Provider Name | KATHRYN E TANNER MD
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Gender | Female
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1000 HEALTH CENTER DR
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City | MATTOON
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State | IL
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Zip | 61938-4644
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Country | US
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Telephone | 661-334-0203
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Fax |
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Provider Business Mailing Address
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Address Line | 3 TEALWOOD CV
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City | CHARLESTON
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State | IL
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Zip | 61920-4407
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Country | US
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Telephone | 956-357-4082
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 2001006985
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License Number State | MO
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