Basic Information
| Provider Information | |||||||||
| NPI: | 1205404449 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TANNER | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | CLAIRE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1319 PUNAHOU ST STE 824 | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968261080 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082036518 | ||||||||
| FaxNumber: | 8089552174 | ||||||||
| Practice Location | |||||||||
| Address1: | 1319 PUNAHOU ST STE 824 | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968261080 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082036518 | ||||||||
| FaxNumber: | 8089552174 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2021 | ||||||||
| LastUpdateDate: | 06/15/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | MDR-8084 | HI | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.