Healthcare Provider Details

I. General information

NPI: 1427999580
Provider Name (Legal Business Name): REVA BLANEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2174 W 325 S
MAPLETON UT
84664-4320
US

IV. Provider business mailing address

2174 W 325 S
MAPLETON UT
84664-4320
US

V. Phone/Fax

Practice location:
  • Phone: 801-615-1421
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number332005-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: