Provider Demographics
NPI:1710240734
Name:MCGOVERN, JOSEPH GUSTAVE (DNP, NP-C)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:GUSTAVE
Last Name:MCGOVERN
Suffix:
Gender:M
Credentials:DNP, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1055 N 500 W
Mailing Address - Street 2:ATTN: CREDENTIALING
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3305
Mailing Address - Country:US
Mailing Address - Phone:801-354-8225
Mailing Address - Fax:801-418-0941
Practice Address - Street 1:700 W 800 N STE 220
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-6306
Practice Address - Country:US
Practice Address - Phone:801-354-8205
Practice Address - Fax:801-354-8206
Is Sole Proprietor?:No
Enumeration Date:2012-06-25
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT6169508-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily