Individual
MEGAN LOUISE BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
466 W 800 S, BLANDING, UT 84511-3901
(435) 459-9682
Mailing address
466 W 800 S, BLANDING, UT 84511-3901
(435) 459-9682
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
11452109-1206
UT
Other
Enumeration date
10/09/2018
Last updated
10/03/2019
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