Provider Demographics
NPI:1457718181
Name:TANNER, SHEENA
Entity Type:Individual
Prefix:
First Name:SHEENA
Middle Name:
Last Name:TANNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22086
Mailing Address - Street 2:
Mailing Address - City:ARCTIC VILLAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99722-0086
Mailing Address - Country:US
Mailing Address - Phone:907-587-5229
Mailing Address - Fax:907-587-5239
Practice Address - Street 1:9998 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:ARCTIC VILLAGE
Practice Address - State:AK
Practice Address - Zip Code:99722-9800
Practice Address - Country:US
Practice Address - Phone:907-587-5229
Practice Address - Fax:907-587-5239
Is Sole Proprietor?:No
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker