Provider Demographics
NPI:1912703448
Name:TANNER, EVELYN (BT)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:TANNER
Suffix:
Gender:
Credentials:BT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 W TRENTON AVE APT 333B
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19067-2081
Mailing Address - Country:US
Mailing Address - Phone:215-791-3041
Mailing Address - Fax:
Practice Address - Street 1:1 PRINCESS DIANA DR
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08638-3803
Practice Address - Country:US
Practice Address - Phone:609-392-2648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician