MEDICARE: MR. DEAN WELTON TANNER MS

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1265762660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DEAN WELTON TANNER MS

Provider Business Mailing Address
First Line	:	4006 ALLAN PL
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-5111
Country	:	US
Telephone Number	:	907-561-8522
Fax Number	:

Provider Business Practice Location Address
First Line	:	4006 ALLAN PL
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-5111
Country	:	US
Telephone Number	:	907-561-8522
Fax Number	:

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

Provider Enumeration Date	:	01/06/2010
Last Update Date	:	01/06/2010

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