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NPI Code Detail

MEDICARE: STACEY BAGANZ BCHN, MS

MEDICARE: STACEY BAGANZ BCHN, MS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133N00000XNutritionist

General Provider Information

NPI Number : 1841665684
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACEY BAGANZ BCHN, MS
Provider Business Mailing Address
First Line : 2499 LEDGER WAY
Second Line :
City : PARK CITY
State : UT
Zip : 84060-1220
Country : US
Telephone Number : 588-248-5343
Fax Number :
Provider Business Practice Location Address
First Line : 2499 LEDGER WAY
Second Line :
City : PARK CITY
State : UT
Zip : 84060-1220
Country : US
Telephone Number : 858-248-5343
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/04/2015
Last Update Date : 11/03/2023

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