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NPI Code Detail

MEDICARE: NANCY LOUISE MECHAM FNP

MEDICARE: NANCY LOUISE MECHAM FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner213672-4405UT

General Provider Information

NPI Number : 1760596365
Entity Type Code : Individual
Provider Name (Legal Business Name) : NANCY LOUISE MECHAM FNP
Provider Business Mailing Address
First Line : PO BOX 27128
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84127-0128
Country : US
Telephone Number : 801-442-5502
Fax Number :
Provider Business Practice Location Address
First Line : 7302 S BINGHAM JUNCTION BLVD
Second Line :
City : MIDVALE
State : UT
Zip : 84047-4804
Country : US
Telephone Number : 801-442-2612
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2006
Last Update Date : 01/26/2017

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