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General NPI Number Information
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NPI Number | 1871199026
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Entity Type | Individual
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Provider Name | AYROWYN TANNER CRNP
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Gender | Female
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Dates
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Enumeration Date | 12/11/2020
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 707 N BROADWAY
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City | BALTIMORE
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State | MD
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Zip | 21205-1832
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Country | US
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Telephone | 443-923-2757
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Fax |
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Provider Business Mailing Address
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Address Line | 707 N BROADWAY
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City | BALTIMORE
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State | MD
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Zip | 21205-1832
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Country | US
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Telephone | 443-923-2757
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | R235108
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 10484809-4405
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License Number State | UT
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