Basic Information
| Provider Information | |||||||||
| NPI: | 1750049706 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VEGLIANTE | ||||||||
| FirstName: | MARIE | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9535 S RAINTREE DR | ||||||||
| Address2: | |||||||||
| City: | SANDY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840923264 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104250205 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4403 HARRISON BLVD STE 4875 | ||||||||
| Address2: | |||||||||
| City: | OGDEN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 844033335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013874500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2021 | ||||||||
| LastUpdateDate: | 02/10/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 12441775-3102 | UT | N | Nursing Service Providers | Registered Nurse | 363LP0200X | 12441775-4405 | UT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.