Individual
MAYRA IBETH VENCES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
1146 N ANTILLES DR, SALT LAKE CITY, UT 84116-4656
(801) 673-8082
Mailing address
1146 N ANTILLES DR, SALT LAKE CITY, UT 84116-4656
(801) 673-8082
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
82272178-4405
UT
Other
Enumeration date
07/25/2019
Last updated
07/25/2019
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