Individual
MRS. ANITA L TANNER
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
6820 NW 23RD ST, BETHANY, OK 73008
(405) 495-0070
(405) 787-0062
Mailing address
2801 PARKLAWN DR, STE 100, MIDWEST CITY, OK 73110-4224
(405) 495-0070
(405) 787-0062
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA693
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100132360A
—
OK
Enumeration date
04/26/2006
Last updated
02/10/2020
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