Mandi Lou Tanner, APRN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

4807317-4405 Issued in UT

Practice address

2512 W 2725 N
Farr West, UT 84404-9469

Phone

(801) 309-6285

Fax

(801) 820-0401

NPI assigned

Sep 9, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 5

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Lotus Aesthetics and Wellness

  • Primary Care Clinic/Center
  • Farr West, UT
  • NPI 1457123358
  NPD
• Aj & B Vandugteren LLP

  dba Therapeutix Massage Centre

  • Specialist
  • Pleasant View, UT
  • NPI 1033568035
  NPD (past)

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

{
    "created_epoch": "1631145600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713139200000",
    "number": "1598434953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2512 W 2725 N",
            "city": "FARR WEST",
            "state": "UT",
            "postal_code": "844049469",
            "telephone_number": "801-309-6285"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2512 W 2725 N",
            "city": "FARR WEST",
            "state": "UT",
            "postal_code": "844049469",
            "telephone_number": "801-309-6285",
            "fax_number": "801-820-0401"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4272 W 1700 S",
            "address_purpose": "LOCATION",
            "city": "Syracuse",
            "state": "UT",
            "postal_code": "840756855",
            "country_code": "US",
            "telephone_number": "816-455-4776",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TANNER",
        "first_name": "MANDI",
        "middle_name": "LOU",
        "credential": "APRN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-09-09",
        "last_updated": "2024-04-15",
        "certification_date": "2024-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "UT",
            "license": "4807317-4405",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "260022408",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "APRN LICENSE",
            "identifier": "4807317-4405",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PIN",
            "identifier": "000055266",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8760003008007",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CONTROLLED SUBSTANCE LICENSE",
            "identifier": "4807317-8900",
            "state": "UT"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mandi@lotusaesthetics.org",
            "affiliation": "N",
            "endpointDescription": "Business Email Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2512 W 2725 N",
            "city": "Farr West",
            "state": "UT",
            "country_code": "US",
            "postal_code": "844049469",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Caitlin Stewart
• Danielle Marie Stewart
• Summit Hand Therapy Limited Partnership
• Sundance Physical Therapy Farr West LLC
• Christy Jean Syndergaard
• Amy Lyn Taylor
• Jessica Opal Tod
• Tree of Life Childrens Center LLC
• Weber County Fire Protection Service Area No. 4 (Weber Fire District)
• Blake Thomas Wellman

• Family Nurse Practitioner in Farr West, UT
• Providers in Farr West, 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 Apr 15, 2024; 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.