Individual
TANNER JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
79568 SUMNER RD., BROKEN BOW, NE 68822
(308) 870-4953
Mailing address
79568 SUMNER RD., BROKEN BOW, NE 68822
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
05/10/2016
Last updated
05/10/2016
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