Individual
MARK BOYACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
1055 N 500 W, SUITE 222, PROVO, UT 84604-3305
(801) 377-4623
(801) 377-6832
Mailing address
1055 N 500 W, CREDENTIALING DEPARTMENT, PROVO, UT 84604-3305
(801) 354-8225
(801) 418-0941
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
279656-4405
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
500030477
PALMETTO GBA
—
Enumeration date
06/12/2006
Last updated
11/27/2023
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