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Individual

MARIE BLACKER BLACKER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PMHNP-C

Contact information

Practice address
1125 W CENTER ST, OREM, UT 84057-5207
(801) 903-5903
Mailing address
1125 W CENTER ST, OREM, UT 84057-5207
(801) 903-5903

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
0000INTERN
UT
363LF0000X
Family Nurse Practitioner
267381-4405
UT
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
267381-4405
UT
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
28201
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1477985513
UT
Enumeration date
09/13/2018
Last updated
03/13/2026
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