Provider Demographics
NPI:1073920799
Name:TANNER, ERIN E (NP)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:E
Last Name:TANNER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:E
Other - Last Name:MAHONEY / KELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:117A STAFFORD ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01603-1440
Mailing Address - Country:US
Mailing Address - Phone:508-854-1055
Mailing Address - Fax:
Practice Address - Street 1:407 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:MA
Practice Address - Zip Code:01562-1909
Practice Address - Country:US
Practice Address - Phone:508-885-9737
Practice Address - Fax:508-885-6139
Is Sole Proprietor?:No
Enumeration Date:2014-07-15
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN258373363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily