Healthcare Provider Details

I. General information

NPI: 1982520631
Provider Name (Legal Business Name): RICK WIRSCH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 S 200 W
BLANDING UT
84511-3910
US

IV. Provider business mailing address

802 S 200 W
BLANDING UT
84511-3910
US

V. Phone/Fax

Practice location:
  • Phone: 801-735-4964
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11307378-8900
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: