Individual
DIRK BRADLEY BAHORAVITCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSN, CRNA
Contact information
Practice address
1067 N 500 W, PROVO, UT 84604-3305
(801) 374-0354
Mailing address
264 N 1020 E, AMERICAN FORK, UT 84003-2957
(801) 592-5424
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
53485
ID
Other
Enumeration date
02/22/2016
Last updated
01/19/2021
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