MEDICARE: DIANA CAROL TANNEY

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	208000000X	Pediatrics Physician	44353	CO

General Provider Information

NPI Number	:	1477511657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA CAROL TANNEY

Provider Business Mailing Address
First Line	:	4745 ARAPAHOE AVE STE 310
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80303-1082
Country	:	US
Telephone Number	:	303-442-2913
Fax Number	:

Provider Business Practice Location Address
First Line	:	4745 ARAPAHOE AVE STE 310
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80303-1082
Country	:	US
Telephone Number	:	303-442-2913
Fax Number	:

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

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	11/15/2007

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Directions to “ DIANA CAROL TANNEY ” Practice Location

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