Provider Demographics
NPI:1538617964
Name:TANNER, VALERIE (A-GNP-C)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:TANNER
Suffix:
Gender:F
Credentials:A-GNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2578 W 600 N
Mailing Address - Street 2:
Mailing Address - City:LINDON
Mailing Address - State:UT
Mailing Address - Zip Code:84042-1260
Mailing Address - Country:US
Mailing Address - Phone:801-896-9868
Mailing Address - Fax:
Practice Address - Street 1:2578 W 600 N
Practice Address - Street 2:
Practice Address - City:LINDON
Practice Address - State:UT
Practice Address - Zip Code:84042-1260
Practice Address - Country:US
Practice Address - Phone:801-896-9868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-14
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5572357-4405207RP1001X, 363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty