Provider Demographics
NPI:1013976380
Name:CATHY TANNER RN
Entity Type:Organization
Organization Name:CATHY TANNER RN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CASE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:TANNER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:608-623-2850
Mailing Address - Street 1:P.O. BOX 13
Mailing Address - Street 2:6132 WILSON STREET
Mailing Address - City:EDMUND
Mailing Address - State:WI
Mailing Address - Zip Code:53535
Mailing Address - Country:US
Mailing Address - Phone:608-623-2850
Mailing Address - Fax:
Practice Address - Street 1:5910 ANTHONY STREET
Practice Address - Street 2:#102 ATTN:GREG PASKE
Practice Address - City:MCFARLAND
Practice Address - State:WI
Practice Address - Zip Code:53558
Practice Address - Country:US
Practice Address - Phone:608-838-5887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI100561163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Single Specialty