Provider Demographics
NPI:1851301246
Name:SPETH, CHAD B (FNP)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:B
Last Name:SPETH
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 E 400 N
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-4120
Mailing Address - Country:US
Mailing Address - Phone:435-752-1010
Mailing Address - Fax:
Practice Address - Street 1:246 E 1260 N
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-7501
Practice Address - Country:US
Practice Address - Phone:435-363-2000
Practice Address - Fax:435-268-2994
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2922994405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTQ39871Medicare UPIN
UT000063537Medicare PIN