MEDICARE: TENNILLE TANNER

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	164W00000X	Licensed Practical Nurse	170337	OH

General Provider Information

NPI Number	:	1366292294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TENNILLE TANNER

Provider Business Mailing Address
First Line	:	1690 LAKENOLL DR APT D
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45231-5152
Country	:	US
Telephone Number	:	513-379-1425
Fax Number	:

Provider Business Practice Location Address
First Line	:	1690 LAKENOLL DR APT D
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45231-5152
Country	:	US
Telephone Number	:	513-379-1425
Fax Number	:

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

Provider Enumeration Date	:	03/25/2024
Last Update Date	:	03/25/2024

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Directions to “ TENNILLE TANNER ” Practice Location

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