Healthcare Provider Details

I. General information

NPI: 1750869228
Provider Name (Legal Business Name): MEGAN BOHMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2018
Last Update Date: 08/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 W 950 S
BRIGHAM CITY UT
84302-3071
US

IV. Provider business mailing address

655 E 1300 N
LOGAN UT
84341-2570
US

V. Phone/Fax

Practice location:
  • Phone: 435-792-6500
  • Fax:
Mailing address:
  • Phone: 435-792-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: