IndividualActive
Blake Lawrence
NPI 1902314289 · Nurse Practitioner · Pleasant Grove, UT
Provider details
- NPI number
- 1902314289
- Entity type
- Individual
- Primary specialty
- Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
- Sex
- Male
- Sole proprietor
- Yes
- License
- 12078815-4405 (UT)
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
Practice location
2100 W Pleasant Grove Blvd Ste 270
Pleasant Grove, UT 84062-3375
Phone: (208) 316-9539
Approximate (ZIP-level) locationGet directions
Mailing address
634 S 1870 W
Orem, UT 84059-4963
Registry dates
- Enumerated
- 2018-01-20
- Last updated
- 2024-01-26
- Certified
- 2023-11-30
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.