Facts
- Status
- A
- Credential
- PMHNP-BC
- Type
- Individual
- Enumeration date
- 2025-10-11
- Last updated
- 2025-10-11
Licenses
- License UT
- NA
Location
- Practice location
- 1062 S BOWERY WAY
- City
- MAPLETON UT
- Postal code
- 846644460
- Phone
- 208-243-4711
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.