NPI 1003570631

Madison Kate Willes

Practitioner Case Manager/Care Coordinator Provo, UT

Practice location

Address: 750 N Freedom Blvd, Provo, UT 84601-1677
Phone: (801) 373-4760
Fax: (801) 373-0639

Registered specialties

Case Manager/Care Coordinator Primary

Other Service Providers Taxonomy 171M00000X Licence Y2368955 (CA)

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Registry record

NPI: 1003570631
Entity type: Individual
Sex (as registered): Female
NPI issued: 29 Oct 2021
Record last updated: 29 Oct 2021

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.