1013976380 NPI number — CATHY TANNER RN

Table of content: (NPI 1013976380)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013976380 NPI number — CATHY TANNER RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CATHY TANNER RN
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013976380
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 13
Provider Second Line Business Mailing Address:
6132 WILSON STREET
Provider Business Mailing Address City Name:
EDMUND
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53535
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-623-2850
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5910 ANTHONY STREET
Provider Second Line Business Practice Location Address:
#102 ATTN:GREG PASKE
Provider Business Practice Location Address City Name:
MCFARLAND
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53558
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-838-5887
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/23/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TANNER
Authorized Official First Name:
CATHY
Authorized Official Middle Name:
JO
Authorized Official Title or Position:
CASE MANAGER
Authorized Official Telephone Number:
608-623-2850

Provider Taxonomy Codes

  • Taxonomy code: 163WC0400X , with the licence number:  100561 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)