Individual
MR. RYAN DENNIS CHURCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
FNP-C
Contact information
Practice address
1220 E 3900 S STE 1F, SALT LAKE CITY, UT 84124-1327
(801) 262-5711
(801) 262-5741
Mailing address
PO BOX 741648, ATLANTA, GA 30374-1648
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
278935-4405
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
27893544001001
BCBS
UT
01
—
P99858
UPIN
UT
Enumeration date
08/11/2005
Last updated
11/11/2020
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