Individual
DEVEN WILLARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BSN, RN
Contact information
Practice address
1350 N 500 E, LOGAN, UT 84341-2400
(435) 716-2800
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
8510230-4405
UT
Other
Enumeration date
05/15/2018
Last updated
03/26/2019
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