IndividualActive
Tack Macgregor, REGISTERED NURSE
NPI 1659914356 · Child & Adolescent Psychiatric/Mental Health Registered Nurse · Provo, UT
Provider details
- NPI number
- 1659914356
- Entity type
- Individual
- Primary specialty
- Child & Adolescent Psychiatric/Mental Health Registered NurseNursing Service Providers
- Credential
- REGISTERED NURSE
- Sex
- Male
- Sole proprietor
- No
- License
- 5554957-3102 (UT)
Specialties & taxonomies
- Child & Adolescent Psychiatric/Mental Health Registered NursePrimary163WP0807XLicense 5554957-3102 (UT)
Nursing Service Providers
Practice location
4501 N University Ave
Provo, UT 84604-5504
Phone: (801) 932-2582
Approximate (ZIP-level) locationGet directions
Mailing address
4501 N University Ave
Provo, UT 84604-5504
Registry dates
- Enumerated
- 2019-10-25
- Last updated
- 2019-10-25
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.