=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720997166
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARSHA TANNER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/02/2026
-----------------------------------------------------
Last Update Date | 09/02/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2963 MAIN ST
-----------------------------------------------------
City | BUFFALO
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14214-1003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-834-9200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1368 NEWELL CRK
-----------------------------------------------------
City | ELDRED
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16731-4812
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 234-855-9010
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | SP037047
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------