Individual
SHANTHA TANNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1524 JACKSON ST, ANDERSON, IN 46016-1621
(269) 252-8381
Mailing address
1524 JACKSON ST, ANDERSON, IN 46016-1621
(269) 252-8381
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
28259661A
IN
374U00000X
Home Health Aide
—
—
376J00000X
Homemaker
—
—
376K00000X
Nurse's Aide
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/22/2022
Last updated
12/26/2022
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