Doctor Name: | STACIE WEEKS MECHAM |
NPI Number: | 1598723470 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | P.N.P. |
License Number: | 2246214405 |
Business Practice Address: | 2380 N 400 E Ste C North Logan, UT - 843411749 |
Business Phone Number: | 4357537337 |
Business Fax Number: | |
Mailing Address: | 2740 North 1000 East, NORTH LOGAN |
State: | UT |
Postal Code: | 84341 |
Phone Number: | 4355125610 |
Fax Number: | |
NPI Enumeration Date: | 05/02/2006 |
NPI Last Update Date: | 12/07/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LP0200X |
License Number: | 2246214405 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | UT |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Pediatrics |
Taxonomy Definition: |