Individual
MARIA ELENA BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN, MSN
Contact information
Practice address
1034 N 500 W, PROVO, UT 84604-3380
(801) 357-7413
Mailing address
1034 N 500 W, PROVO, UT 84604-3380
(801) 357-7413
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
198112-4405
UT
Other
Enumeration date
08/12/2008
Last updated
08/12/2008
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