Provider Demographics
NPI:1275197196
Name:MANWARING, TANNER JOHN (DNP, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:TANNER
Middle Name:JOHN
Last Name:MANWARING
Suffix:
Gender:M
Credentials:DNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 N TRIUMPH BLVD STE 500
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-6475
Mailing Address - Country:US
Mailing Address - Phone:801-821-2781
Mailing Address - Fax:801-901-1194
Practice Address - Street 1:3300 N TRIUMPH BLVD STE 500
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-6475
Practice Address - Country:US
Practice Address - Phone:801-821-2781
Practice Address - Fax:801-901-1194
Is Sole Proprietor?:No
Enumeration Date:2019-04-25
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9265315-4405363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health