Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 7900097-4405 | UT |
NPI | 1073277802 |
---|---|
Provider Name | Mckenzie Blatt |
First Address | Murray, UT 84107-5076 |
Second Address | Slc, UT 84132-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2021 |
Last Update Date | 27/10/2021 |