Individual
AUGUSTA BLACKSTONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
500 FOOTHILL DR, SALT LAKE CITY, UT 84148-0001
(801) 582-1565
Mailing address
500 FOOTHILL DR, SALT LAKE CITY, UT 84148
(801) 582-1565
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
07/22/2024
Last updated
07/22/2024
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