Mary Tanner, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

10834924-4405 Issued in UT

Practice address

720 N 530 E
Orem, UT 84097-4104

Phone

(385) 498-7506

NPI assigned

Jun 12, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Mary Mitton Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Aloha Ketamine and Wellness LLC

  • Family Medicine Physician
  • Orem, UT
  • NPI 1477309581
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1686528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686528000000",
    "number": "1558045583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1109 N TEMPLE DR",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846041704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 N 530 E",
            "city": "OREM",
            "state": "UT",
            "postal_code": "840974104",
            "telephone_number": "385-498-7506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TANNER",
        "first_name": "MARY",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-06-12",
        "last_updated": "2023-06-12",
        "certification_date": "2023-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "UT",
            "license": "10834924-4405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "MITTON",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Sidney Kameali'I Phillips Tanaka, AUD
• Tangible Mental Health
• Brynna Lynn Tanner
• Hannah Tanner, BCBA, MS, BA, LBA
• Kirstin Tanner
• Michelle Tanner, CRT
• Scott Mason Tanner
• Savannah Taosoga
• Aouliulifolau Mele Tavita, LPN
• Alexandra N Taylor

• Family Nurse Practitioner in Orem, UT
• Providers in Orem, UT by specialty
• Family Nurse Practitioner in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.