Provider Demographics
NPI:1437731122
Name:MAVILIA, NANCI JANE
Entity Type:Individual
Prefix:
First Name:NANCI
Middle Name:JANE
Last Name:MAVILIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 S 400 E STE 335
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-5316
Mailing Address - Country:US
Mailing Address - Phone:801-433-2595
Mailing Address - Fax:
Practice Address - Street 1:1264 N CEDAR BLVD APT B202
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84721-8939
Practice Address - Country:US
Practice Address - Phone:720-645-6079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist