Individual
MISTY LYNN BOOZENNY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
750 N FREEDOM BLVD, PROVO, UT 84601-1677
(801) 373-4760
(801) 373-0639
Mailing address
1338 S 2320 E, SPANISH FORK, UT 84660-6419
(801) 979-8105
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
952
UT
Other
Enumeration date
01/15/2019
Last updated
01/15/2019
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