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NPI Code Detail

MEDICARE: TANNER JACOB LUND

MEDICARE: TANNER JACOB LUND
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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1235762261
Entity Type Code : Individual
Provider Name (Legal Business Name) : TANNER JACOB LUND
Provider Business Mailing Address
First Line : 7100 W ALEXANDER RD APT 1078
Second Line :
City : LAS VEGAS
State : NV
Zip : 89129-1701
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7365 PRAIRIE FALCON RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89128-0807
Country : US
Telephone Number : 702-766-9840
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/18/2020
Last Update Date : 01/14/2025

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Directions to “ TANNER JACOB LUND ” Practice Location

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