Individual
TANNER CAVANAUGH
Active
Individual
TANNER CAVANAUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
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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