Individual
TACK D MACGREGOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
REGISTERED NURSE
Contact information
Practice address
4501 N UNIVERSITY AVE, PROVO, UT 84604-5504
(801) 932-2582
Mailing address
4501 N UNIVERSITY AVE, PROVO, UT 84604-5504
Taxonomy
Speciality
Code
Description
License number
State
163WP0807X
Child & Adolescent Psychiatric/Mental Health Registered Nurse
Primary
5554957-3102
UT
Other
Enumeration date
10/25/2019
Last updated
10/25/2019
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