Provider Demographics
NPI:1750899712
Name:TANNER, BRENDA (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:TANNER
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21723 BLACK OWL DR
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-1595
Mailing Address - Country:US
Mailing Address - Phone:281-813-4810
Mailing Address - Fax:281-869-4643
Practice Address - Street 1:140 CYPRESS STATION DR # 100-34
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-1633
Practice Address - Country:US
Practice Address - Phone:832-856-8006
Practice Address - Fax:281-869-4643
Is Sole Proprietor?:No
Enumeration Date:2018-01-11
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX886469163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse