Provider Demographics
NPI:1588604508
Name:TANNER, ELIZABETH W (CRNP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:W
Last Name:TANNER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:H
Other - Last Name:MCINERNY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 548
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35602-0548
Mailing Address - Country:US
Mailing Address - Phone:256-350-9700
Mailing Address - Fax:256-350-9797
Practice Address - Street 1:1874 BELTLINE RD SW
Practice Address - Street 2:SUITE 300
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-5514
Practice Address - Country:US
Practice Address - Phone:256-350-9700
Practice Address - Fax:256-350-9797
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-099396363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health