Provider Demographics
NPI:1073920799
Name:TANNER, ERIN E (NP)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:E
Last Name:TANNER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:E
Other - Last Name:MAHONEY / KELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:579 PLEASANT ST STE 1
Mailing Address - Street 2:
Mailing Address - City:PAXTON
Mailing Address - State:MA
Mailing Address - Zip Code:01612-1307
Mailing Address - Country:US
Mailing Address - Phone:508-978-1945
Mailing Address - Fax:508-213-3675
Practice Address - Street 1:579 PLEASANT ST STE 1
Practice Address - Street 2:
Practice Address - City:PAXTON
Practice Address - State:MA
Practice Address - Zip Code:01612-1307
Practice Address - Country:US
Practice Address - Phone:508-978-1945
Practice Address - Fax:508-213-3675
Is Sole Proprietor?:No
Enumeration Date:2014-07-15
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN258373363LF0000X
MA258373363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily