Healthcare Provider Details

I. General information

NPI: 1760596365
Provider Name (Legal Business Name): NANCY LOUISE MECHAM FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 01/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7302 S BINGHAM JUNCTION BLVD
MIDVALE UT
84047-4804
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-442-2612
  • Fax:
Mailing address:
  • Phone: 801-442-5502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number213672-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: