Provider Information for 1083182422
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ANITA K TANNER LMSW
Sex: Female
NPI: 1083182422
Last Updated: 2021-05-07
Certification Date: 2021-05-07
Certification Date: 2021-05-07
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1083182422 | ||||||||||||
| Enumeration Date | 2018-11-04 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 27665 YVETTE DR WARREN, MI 48088-4712 United States Phone: 248-719-6292 | Fax: | ||||||||||||
| Primary Practice Address | 30400 TELEGRAPH RD STE 334 BINGHAM FARMS, MI 48025-4573 United States Phone: 800-311-5365 | Fax: | ||||||||||||
| Secondary Practice Address(es) | 27665 YVETTE DR | ||||||||||||
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