Provider Demographics
NPI:1538687967
Name:WESTON, NANCY
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:WESTON
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:PO BOX 126
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:UT
Mailing Address - Zip Code:84064-0126
Mailing Address - Country:US
Mailing Address - Phone:435-200-5612
Mailing Address - Fax:435-793-3021
Practice Address - Street 1:120 S MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:UT
Practice Address - Zip Code:84064-7701
Practice Address - Country:US
Practice Address - Phone:435-771-6799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-06
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5676921-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner