Individual
MARY TANNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
720 N 530 E, OREM, UT 84097-4104
(385) 498-7506
Mailing address
1109 N TEMPLE DR, PROVO, UT 84604-1704
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
10834924-4405
UT
Other
Enumeration date
06/12/2023
Last updated
06/12/2023
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