Individual
DAWN CLARISSE TANNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
221 NE GLEN OAK AVE, PEORIA, IL 61603-4307
(309) 672-5522
Mailing address
21276 NETWORK PL, CHICAGO, IL 60673-1212
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085-002863
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00841537
RRMCARE THRU CES
IL
Enumeration date
12/18/2006
Last updated
07/13/2011
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