Individual
MANDI LOU TANNER
Active
Individual
MANDI LOU TANNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4807317-4405
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000055266
MEDICARE PIN
UT
01
—
260022408
RAILROAD MEDICARE
UT
01
—
4807317-4405
APRN LICENSE
UT
01
—
4807317-8900
CONTROLLED SUBSTANCE LICENSE
UT
05
—
8760003008007
—
UT
Enumeration date
09/09/2021
Last updated
04/15/2024
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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