Provider Demographics
NPI:1720441918
Name:WHITTAKER, TANNER
Entity Type:Individual
Prefix:
First Name:TANNER
Middle Name:
Last Name:WHITTAKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6830 XAVIER CIR
Mailing Address - Street 2:UNIT 3
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80030-5714
Mailing Address - Country:US
Mailing Address - Phone:303-552-6125
Mailing Address - Fax:
Practice Address - Street 1:6830 XAVIER CIR
Practice Address - Street 2:UNIT 3
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80030-5714
Practice Address - Country:US
Practice Address - Phone:303-552-6125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-04
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No175T00000XOther Service ProvidersPeer Specialist
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
No372600000XNursing Service Related ProvidersAdult Companion
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376J00000XNursing Service Related ProvidersHomemaker