Provider Demographics
NPI:1063209039
Name:HALLMAN, TANNER WESLEY
Entity type:Individual
Prefix:
First Name:TANNER
Middle Name:WESLEY
Last Name:HALLMAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2817 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-1305
Mailing Address - Country:US
Mailing Address - Phone:308-660-2159
Mailing Address - Fax:
Practice Address - Street 1:11011 Q ST STE 101C
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-3700
Practice Address - Country:US
Practice Address - Phone:402-697-5121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEH13919083372500000X, 3747P1801X, 372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No372500000XNursing Service Related ProvidersChore Provider
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant