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NPI Code Detail

MEDICARE: ANDRUS TANNER

MEDICARE: ANDRUS 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
1106S00000XBehavior Technician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1497465769
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDRUS TANNER
Provider Business Mailing Address
First Line : 4717 E MCDOWELL RD
Second Line :
City : PHOENIX
State : AZ
Zip : 85008-4544
Country : US
Telephone Number : 252-266-1478
Fax Number :
Provider Business Practice Location Address
First Line : 4717 E MCDOWELL RD
Second Line :
City : PHOENIX
State : AZ
Zip : 85008-4544
Country : US
Telephone Number : 252-266-1478
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/28/2022
Last Update Date : 11/28/2022

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Directions to “ ANDRUS TANNER ” Practice Location

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