Provider Demographics
NPI:1255469409
Name:TANNER, SHERRY S (RN)
Entity type:Individual
Prefix:MRS
First Name:SHERRY
Middle Name:S
Last Name:TANNER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 S OAK RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-5328
Mailing Address - Country:US
Mailing Address - Phone:843-317-4073
Mailing Address - Fax:843-317-4080
Practice Address - Street 1:325 S OAK RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-5328
Practice Address - Country:US
Practice Address - Phone:843-317-4073
Practice Address - Fax:843-317-4080
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17017163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC376241Medicaid
SC3337Medicare ID - Type Unspecified