Individual
LAURA STEFFEN TANNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1124 GALLERY PARK BOULEVARD, #200, WILMINGTON, NC 28412
(910) 395-3477
(910) 815-3479
Mailing address
2421 SILVER STREAM LANE, WILMINGTON, NC 28401-0000
(910) 395-3477
(910) 815-3479
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
34176
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070008802
RAILROAD MEDICARE
NC
01
—
8149B
BCBS NC
NC
05
—
898149B
—
NC
Enumeration date
10/12/2006
Last updated
01/22/2020
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