Individual
MRS. DEANNA WADE TANNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110002513
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10029494P
OPTIMA/SENTARA
VA
05
—
1508088075
—
VA
01
—
61459602
BLACK LUNG/FECA
VA
Enumeration date
04/26/2007
Last updated
08/12/2013
Update your record
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