Organization
SAGE FUNCTIONAL MEDICINE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA SHEA ROBERTS A.P.R.N, WHNP, FNP (OWNER/OPERATOR)
(435) 760-7078
Entity
Organization
Contact information
Practice address
55 E 100 N, SUITE 303, LOGAN, UT 84321-4661
(435) 760-7078
Mailing address
55 E 100 N, SUITE 303, LOGAN, UT 84321-4661
(435) 760-7078
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
8689112-4405
UT
Other
Enumeration date
03/09/2016
Last updated
03/09/2016
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