Healthcare Provider Details

I. General information

NPI: 1427981182
Provider Name (Legal Business Name): MAEGAN BONNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E BURKHILL DR
EAGLE MOUNTAIN UT
84005-5266
US

IV. Provider business mailing address

1250 E BURKHILL DR
EAGLE MOUNTAIN UT
84005-5266
US

V. Phone/Fax

Practice location:
  • Phone: 435-777-4057
  • Fax: 435-777-4057
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number11613521-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: