Individual
MR. TONY TANNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSSII
Contact information
Practice address
3333 E BROADWAY AVE STE 1214, BISMARCK, ND 58501-3395
(701) 581-3531
Mailing address
3333 E BROADWAY AVE STE 1214, BISMARCK, ND 58501-3395
(701) 581-3531
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1578322293
—
ND
Enumeration date
05/17/2024
Last updated
05/17/2024
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