Provider Demographics
NPI:1891560462
Name:BLATNICK, ENOCH
Entity Type:Individual
Prefix:
First Name:ENOCH
Middle Name:
Last Name:BLATNICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1958 E SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84040-5711
Mailing Address - Country:US
Mailing Address - Phone:801-656-7781
Mailing Address - Fax:
Practice Address - Street 1:1958 E SUNSET DR
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84040-5711
Practice Address - Country:US
Practice Address - Phone:801-656-7781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-23
Last Update Date:2023-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744R1103XOther Service ProvidersSpecialistResearch Data Abstracter/Coder
No174H00000XOther Service ProvidersHealth Educator