Provider Demographics
NPI:1952795528
Name:TANNER, DEANNEA (RD)
Entity Type:Individual
Prefix:
First Name:DEANNEA
Middle Name:
Last Name:TANNER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39131 S RODEO BUCKLE DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85739-5933
Mailing Address - Country:US
Mailing Address - Phone:520-289-6055
Mailing Address - Fax:520-818-2939
Practice Address - Street 1:7400N ORACLE RD 162S
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-6585
Practice Address - Country:US
Practice Address - Phone:520-289-6055
Practice Address - Fax:520-818-2939
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-23
Last Update Date:2015-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered