Individual
STACIE EGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
5740 CRESTWOOD DR, OGDEN, UT 84405-4869
(801) 475-3380
(801) 475-3381
Mailing address
PO BOX 5546, DENVER, CO 80217-5546
(801) 475-3075
(801) 475-3076
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
7979937-3102
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
U000099109
MEDICARE PTAN
UT
Enumeration date
09/16/2017
Last updated
12/04/2019
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