=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255845665
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MERIDITH GLADE LIND APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/21/2017
-----------------------------------------------------
Last Update Date | 11/21/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 41 E 1140 N STE B
-----------------------------------------------------
City | SARATOGA SPRINGS
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84045-5430
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-407-6500
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1279 PINE RIDGE CIR
-----------------------------------------------------
City | ALPINE
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84004-1745
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-380-4604
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | F11170293
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------