Individual
MRS. CAROL SUE TANNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
672 W 400 S STE 201, SPRINGVILLE, UT 84663-3170
(801) 369-8989
(801) 704-9741
Mailing address
672 W 400 S STE 201, SPRINGVILLE, UT 84663-3170
(801) 369-8989
(801) 704-9741
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5206678-1206
UT
363AM0700X
Medical Physician Assistant
5206678-1206
UT
Other
Enumeration date
05/08/2007
Last updated
11/08/2020
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