# MRS. TYWANNA R TANNER

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1518438332
- **Gender:** F
- **Credential:** NURSE PRACTITIONER

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QP3300X | Pain Clinic/Center | — | NULL | — |
| 363L00000X | Nurse Practitioner | 4704264238 | MI | Yes |

## Other

- **Enumeration date:** 12/06/2018
- **Last updated:** 09/01/2021