Provider Demographics
NPI:1164770947
Name:TANNER, OLGA C
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:C
Last Name:TANNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 E BRANT CIR
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-2520
Mailing Address - Country:US
Mailing Address - Phone:907-355-7026
Mailing Address - Fax:907-338-7162
Practice Address - Street 1:1255 E BRANT CIR
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-2520
Practice Address - Country:US
Practice Address - Phone:907-355-7026
Practice Address - Fax:907-338-7162
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-27
Last Update Date:2025-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1759790251B00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No171M00000XOther Service ProvidersCase Manager/Care Coordinator