Most Relevant Information
Provider Data
| NPI Number: | 1003382110 |
| Provider Name: | NICHOLAS BLAISE MCDONALD |
| Entity Type: | Individual |
| Taxonomy Code: | 101YM0800X |
| Specialty: | Counselor |
| License Number: | 10903648-6009 |
Most Important Dates
| Enumeration Date: | 10/16/2018 |
| Last Updated: | 10/16/2018 |
Provider Practice Location
1141 E 3900 S STE A170
MILLCREEK
UT
841241250
Practice Location Phone/Fax
| Phone: | 8889494864 |
| Fax: |
Provider Mailing Location
4460 S HIGHLAND DR
SALT LAKE CITY
UT
841243543
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |