Individual
STACIE KAY MITANI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
750 NORTH 200 WEST, PROVO, UT 84601
(801) 373-4760
(801) 373-0639
Mailing address
750 NORTH 200 WEST, PROVO, UT 84601
(801) 373-4760
(801) 373-0639
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
1834683102
UT
Other
Enumeration date
08/31/2006
Last updated
07/08/2007
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