Individual
TANNER WINGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2310 N 400 E STE A, LOGAN, UT 84341-1796
(435) 787-2000
(435) 787-1913
Mailing address
PO BOX 30015, DEPT 214, SALT LAKE CITY, UT 84130-0015
(435) 787-2000
(435) 787-1913
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
12485839-1206
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12485839-1206
LICENSE
UT
Enumeration date
06/15/2020
Last updated
10/13/2021
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