Provider Demographics
NPI:1619564853
Name:HURD, TANNER
Entity Type:Individual
Prefix:
First Name:TANNER
Middle Name:
Last Name:HURD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:BUCKHANNON
Mailing Address - State:WV
Mailing Address - Zip Code:26201-2465
Mailing Address - Country:US
Mailing Address - Phone:304-931-8155
Mailing Address - Fax:
Practice Address - Street 1:134 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:BUCKHANNON
Practice Address - State:WV
Practice Address - Zip Code:26201-2465
Practice Address - Country:US
Practice Address - Phone:304-931-8155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant