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General NPI Number Information
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NPI Number | 1912703448
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Entity Type | Individual
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Provider Name | EVELYN TANNER BT
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Gender | Female
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Dates
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Enumeration Date | 02/24/2025
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Last Update Date | 02/24/2025
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Provider Practice Location Address
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Address Line | 1 PRINCESS DIANA DR
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City | TRENTON
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State | NJ
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Zip | 08638-3803
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Country | US
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Telephone | 609-392-2648
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Fax |
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Provider Business Mailing Address
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Address Line | 254 W TRENTON AVE APT 333B
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City | MORRISVILLE
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State | PA
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Zip | 19067-2081
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Country | US
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Telephone | 215-791-3041
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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