Individual
BLAKE LAWRENCE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2100 W PLEASANT GROVE BLVD STE 270, PLEASANT GROVE, UT 84062-3375
(208) 316-9539
Mailing address
634 S 1870 W, OREM, UT 84059-4963
(208) 316-9539
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
12078815-4405
UT
Other
Enumeration date
01/20/2018
Last updated
01/26/2024
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