Individual
TANNER LEE RISNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
697 LOUISIANA RD, DYESS AFB, TX 79607-1141
(325) 696-6600
Mailing address
2910 B ST APT 12, ROSAMOND, CA 93560-7862
(567) 674-9135
Taxonomy
Speciality
Code
Description
License number
State
1710I1003X
Independent Duty Medical Technicians
Primary
1487214649
TX
374700000X
Technician
Primary
—
—
Other
Enumeration date
06/19/2019
Last updated
06/02/2026
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