Provider Demographics
NPI:1003606443
Name:TANNER, JEANNIE CATHERINE
Entity type:Individual
Prefix:
First Name:JEANNIE
Middle Name:CATHERINE
Last Name:TANNER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9622 WILDGRASS CT
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77498-7545
Mailing Address - Country:US
Mailing Address - Phone:281-837-6650
Mailing Address - Fax:
Practice Address - Street 1:9622 WILDGRASS CT
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77498-7545
Practice Address - Country:US
Practice Address - Phone:281-837-6650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX986213163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant