Provider Demographics
NPI:1174418743
Name:MCBRIDE, VONDA MICHELLE (APRN)
Entity type:Individual
Prefix:
First Name:VONDA
Middle Name:MICHELLE
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 W 465 N STE 601
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:UT
Mailing Address - Zip Code:84332-8006
Mailing Address - Country:US
Mailing Address - Phone:801-515-5564
Mailing Address - Fax:
Practice Address - Street 1:560 W 465 N STE 601
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:UT
Practice Address - Zip Code:84332-8006
Practice Address - Country:US
Practice Address - Phone:801-515-5564
Practice Address - Fax:385-364-0600
Is Sole Proprietor?:No
Enumeration Date:2025-06-12
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8170080-4405363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health