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Individual

TANNER CAVANAUGH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
3105 MCHENRY AVE STE 101, MODESTO, CA 95350-1439
(209) 575-2700
Mailing address
PO BOX 130, OWYHEE, NV 89832

Taxonomy

Speciality
Code
Description
License number
State
146N00000X
Basic Emergency Medical Technician
74381
NV
363AM0700X
Medical Physician Assistant
Primary
59206
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
74381
EMT LICENSCE
NV
Enumeration date
12/04/2014
Last updated
05/17/2021
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