Provider Demographics
NPI:1720725930
Name:STAPP, NATALIE MAE
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:MAE
Last Name:STAPP
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 1:122 E 1700 S BLDG 3
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84606-5644
Mailing Address - Country:US
Mailing Address - Phone:801-375-5125
Mailing Address - Fax:
Practice Address - Street 1:122 E 1700 S BLDG 3
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84606-5644
Practice Address - Country:US
Practice Address - Phone:801-472-3902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-18
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT116272121206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant