Provider Demographics
NPI:1396390845
Name:PENNY LEAH TANNER, P.S.
Entity Type:Organization
Organization Name:PENNY LEAH TANNER, P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:L
Authorized Official - Last Name:TANNER
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:253-581-6106
Mailing Address - Street 1:7424 BRIDGEPORT WAY W STE 302
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-8135
Mailing Address - Country:US
Mailing Address - Phone:253-581-6106
Mailing Address - Fax:253-581-6275
Practice Address - Street 1:7424 BRIDGEPORT WAY W STE 302
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-8135
Practice Address - Country:US
Practice Address - Phone:253-581-6106
Practice Address - Fax:253-581-6275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-01
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty