Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 209016609 | IL |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 209.016609 | IL |
NPI | 1003327834 |
---|---|
Provider Name | Ms. Tanya Stann |
First Address | Wheaton, IL 60189-2038 |
Second Address | Wheaton, IL 60189-2038 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2017 |
Last Update Date | 31/08/2021 |