Individual
MARY WILSON BASSIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN, BC
Contact information
Practice address
2005 E 2700 S STE 180, SALT LAKE CITY, UT 84109-1759
(801) 746-7190
Mailing address
2285 COTTONWOOD CIR, HOLLADAY, UT 84117-7601
(801) 424-9108
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
5207201-8900
UT
Other
Enumeration date
05/23/2007
Last updated
07/12/2007
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