Individual
MS. MARSHA ANN TANNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MT(AMT)
Contact information
Practice address
452 SCR 60, MIZE, MS 39116-5350
(601) 678-7784
Mailing address
452 SCR 60, MIZE, MS 39116-5350
(601) 678-7784
Taxonomy
Speciality
Code
Description
License number
State
246RM2200X
Medical Laboratory Technician
CLP.201475-GEN
LA
291U00000X
Clinical Medical Laboratory
Primary
211278
—
291U00000X
Clinical Medical Laboratory
MLT 43092
—
Other
Enumeration date
08/28/2012
Last updated
11/14/2012
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