Provider Demographics
NPI:1083743769
Name:TANNER, CATHERINE D (FNP)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:D
Last Name:TANNER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 SUMMIT STREET
Mailing Address - Street 2:THIRD FLOOR, SUITE 3602
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609
Mailing Address - Country:US
Mailing Address - Phone:510-869-6500
Mailing Address - Fax:510-869-6677
Practice Address - Street 1:3100 SUMMIT ST
Practice Address - Street 2:THIRD FLOOR, SUITE 3206
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3412
Practice Address - Country:US
Practice Address - Phone:510-869-6511
Practice Address - Fax:510-869-6677
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17122363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily