Provider Demographics
NPI:1255845665
Name:LIND, MERIDITH GLADE (APRN)
Entity Type:Individual
Prefix:
First Name:MERIDITH
Middle Name:GLADE
Last Name:LIND
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MERIDITH
Other - Middle Name:JAYNE
Other - Last Name:GLADE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1279 PINE RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:UT
Mailing Address - Zip Code:84004-1745
Mailing Address - Country:US
Mailing Address - Phone:801-380-4604
Mailing Address - Fax:
Practice Address - Street 1:41 E 1140 N STE B
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:UT
Practice Address - Zip Code:84045-5430
Practice Address - Country:US
Practice Address - Phone:801-407-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-21
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTF11170293363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner