MEDICARE: CATHERINE D TANNER FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	17122	CA

General Provider Information

NPI Number	:	1083743769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE D TANNER FNP

Provider Business Mailing Address
First Line	:	3100 SUMMIT STREET
Second Line	:	THIRD FLOOR, SUITE 3602
City	:	OAKLAND
State	:	CA
Zip	:	94609
Country	:	US
Telephone Number	:	510-869-6500
Fax Number	:	510-869-6677

Provider Business Practice Location Address
First Line	:	3100 SUMMIT ST
Second Line	:	THIRD FLOOR, SUITE 3206
City	:	OAKLAND
State	:	CA
Zip	:	94609-3412
Country	:	US
Telephone Number	:	510-869-6511
Fax Number	:	510-869-6677

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	09/16/2015

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