Provider Demographics
NPI:1689361131
Name:STARKEY, MESA SPRING
Entity Type:Individual
Prefix:
First Name:MESA
Middle Name:SPRING
Last Name:STARKEY
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 1:839 E ELGIN AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-1603
Mailing Address - Country:US
Mailing Address - Phone:406-871-5319
Mailing Address - Fax:
Practice Address - Street 1:839 E ELGIN AVE
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-1603
Practice Address - Country:US
Practice Address - Phone:406-871-5319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10219019-3102163WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0200XNursing Service ProvidersRegistered NurseOncology