Individual
MCKELL MITANI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
750 N FREEDOM BLVD, PROVO, UT 84601-1677
(801) 373-4760
(801) 373-0639
Mailing address
750 N FREEDOM BLVD, PROVO, UT 84601-1677
(801) 373-4760
(801) 373-0639
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
6782411-3102
UT
Other
Enumeration date
02/16/2022
Last updated
02/16/2022
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