Provider Demographics
NPI:1063193704
Name:PUICH, EMELY (RN)
Entity type:Individual
Prefix:
First Name:EMELY
Middle Name:
Last Name:PUICH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13037 S MUZZLE LOADER DR
Mailing Address - Street 2:
Mailing Address - City:HERRIMAN
Mailing Address - State:UT
Mailing Address - Zip Code:84096-5761
Mailing Address - Country:US
Mailing Address - Phone:801-647-1767
Mailing Address - Fax:
Practice Address - Street 1:682 W 210 N
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:UT
Practice Address - Zip Code:84045-3143
Practice Address - Country:US
Practice Address - Phone:801-610-8728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5180924-3102163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse