Provider Demographics
NPI:1629208608
Name:ANDERSON, TANNA LYNN (APRN-NP)
Entity Type:Individual
Prefix:
First Name:TANNA
Middle Name:LYNN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:APRN-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12055 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-3452
Mailing Address - Country:US
Mailing Address - Phone:402-884-2632
Mailing Address - Fax:
Practice Address - Street 1:987740 NEBRASKA MEDICAL CTR
Practice Address - Street 2:NEONATAL INTENSIVE CARE UNIT
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-7740
Practice Address - Country:US
Practice Address - Phone:402-559-4442
Practice Address - Fax:402-559-8685
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-23
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111041363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal