Basic Information
| Provider Information | |||||||||
| NPI: | 1366724494 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | OLGA C TANNER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1132 S. CHUGACH STREET | ||||||||
| Address2: | |||||||||
| City: | PALMER | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9077615020 | ||||||||
| FaxNumber: | 9077455489 | ||||||||
| Practice Location | |||||||||
| Address1: | 1132 S. CHUGACH STREET | ||||||||
| Address2: | |||||||||
| City: | PALMER | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9077455454 | ||||||||
| FaxNumber: | 9077465173 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2011 | ||||||||
| LastUpdateDate: | 10/26/2011 | ||||||||
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| AuthorizedOfficialLastName: | TANNER | ||||||||
| AuthorizedOfficialFirstName: | OLGA | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | CARE COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 9077615020 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | AK | Y | Agencies | Case Management |
No ID Information.