Individual
COREEN TANNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
22 BRAMHALL ST, PORTLAND, ME 04102-3134
(207) 662-2526
Mailing address
22 BRAMHALL ST, PORTLAND, ME 04102-3134
(207) 662-2526
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RNA203057
ME
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000000
—
—
Enumeration date
06/05/2018
Last updated
07/21/2022
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