Individual
MATTHEW JASON TANNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1015 MICHIGAN AVE, LOGANSPORT, IN 46947-1526
(574) 722-5151
Mailing address
3203 SUSAN DR, KOKOMO, IN 46902-7506
(765) 419-0610
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
28177692A
IN
Other
Enumeration date
09/16/2019
Last updated
09/16/2019
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