Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 6985371-4405 | UT |
NPI | 1013335215 |
---|---|
Provider Name | Megan Bliss |
First Address | Cedar City, UT 84721-6181 |
Second Address | West Jordan, UT 84088-4506 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2014 |
Last Update Date | 24/02/2017 |