Individual
MAUREEN BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
5121 S COTTONWOOD ST, IM WOMEN AND CHILDREN ADMINISTRATION 15400-15541, MURRAY, UT 84107-5701
(801) 507-7673
Mailing address
3741 W 12600 S, MOM BABY UNIT, RIVERTON, UT 84065-7215
(801) 285-2303
Taxonomy
Speciality
Code
Description
License number
State
282NW0100X
Women's Hospital
Primary
290597-3102
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
942854057
—
UT
Enumeration date
11/03/2015
Last updated
11/03/2015
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