network|NPI|TIN|Name|FirstName|MI|LastName|Degree|Specialty|Address|City|State|Zip|Phone|TermDate|ReportDate
WISE|1023049335|836000025|ROGER A BLAKE|ROGER|A|BLAKE|MD|Critical Care|2221 ELM ST|RAWLINS|WY|82301|3073242221|2024-08-28|2024-10-16
WISE|1023049335|836000025|ROGER A BLAKE|ROGER|A|BLAKE|MD|Critical Care|2221 ELM ST STE A-1|RAWLINS|WY|82301|3073246022|2024-08-28|2024-10-16
WISE|1023049335|836000025|ROGER A BLAKE|ROGER|A|BLAKE|MD|Critical Care|P.O. BOX 460|RAWLINS|WY|82301||2024-08-28|2024-10-16
WISE|1033435045|870281028|SCOTT D EVANS|SCOTT|D|EVANS|MD|Orthopedic Surgery|1055 N 500 W STE 207|PROVO|UT|84604|8013754263|2024-09-18|2024-10-16
WISE|1033435045|870281028|SCOTT D EVANS|SCOTT|D|EVANS|MD|Orthopedic Surgery|1184 E 80 N|AMERICAN FORK|UT|84003|8017633885|2024-09-18|2024-10-16
WISE|1033435045|870281028|SCOTT D EVANS|SCOTT|D|EVANS|MD|Orthopedic Surgery|972 N 600 E|SPANISH FORK|UT|84660|8013737350|2024-09-18|2024-10-16
WISE|1033836598|471497384|NAIM QAQISH|NAIM||QAQISH|MD|Diagnostic Radiology|50 N MEDICAL DR|SALT LAKE CITY|UT|84132|8015812121|2024-06-26|2024-10-16
WISE|1053085050|870281028|MARIA R HOEGH|MARIA|R|HOEGH|NP|Nurse Practitioner|1055 N 500 W BLDG A|PROVO|UT|84604|8014290057|2024-08-23|2024-10-16
WISE|1083315220|852975223|AUBREY R GEORGE|AUBREY|R|GEORGE|APRN|Nurse Practitioner|12391 S 4000 W|HERRIMAN|UT|84096|8013021700|2024-08-31|2024-10-16
WISE|1083315220|870284475|AUBREY R GEORGE|AUBREY|R|GEORGE|APRN|Nurse Practitioner|12391 S 4000 W|HERRIMAN|UT|84096|8013021700|2024-08-31|2024-10-16
WISE|1164405270|836000025|MARK SHAPIRO|MARK||SHAPIRO|MD|General Surgery|2221 ELM ST STE A-1|RAWLINS|WY|82301|3073246022|2024-08-28|2024-10-16
WISE|1164405270|836000025|MARK SHAPIRO|MARK||SHAPIRO|MD|General Surgery|2221 W ELM ST|RAWLINS|WY|82301|3073242221|2024-08-28|2024-10-16
WISE|1164405270|836000025|MARK SHAPIRO|MARK||SHAPIRO|MD|General Surgery|P.O. BOX 460|RAWLINS|WY|82301||2024-08-28|2024-10-16
WISE|1164955274|876000525|DANIEL J ST CLAIR|DANIEL|J|ST CLAIR|OT|Occupational Therapy|1950 CIR OF HOPE DR|SALT LAKE CITY|UT|84112|8015877000|2024-07-31|2024-10-16
WISE|1174085344|471497384|GUINN E DUNN|GUINN|E|DUNN|MD|Hospitalist|1950 CIR OF HOPE DR|SALT LAKE CITY|UT|84112|8015850100|2024-08-31|2024-10-16
WISE|1174085344|471497384|GUINN E DUNN|GUINN|E|DUNN|MD|Hospitalist|50 N MEDICAL DR|SALT LAKE CITY|UT|84132|8015817818|2024-08-31|2024-10-16
WISE|1174085344|471497384|GUINN E DUNN|GUINN|E|DUNN|MD|Hospitalist|501 S CHIPETA WAY|SALT LAKE CITY|UT|84108|8015832500|2024-08-31|2024-10-16
WISE|1174085344|471497384|GUINN E DUNN|GUINN|E|DUNN|MD|Hospitalist|85 N MEDICAL DR|SALT LAKE CITY|UT|84112|8015817818|2024-08-31|2024-10-16
WISE|1265107536|471497384|TARA GREENLEY|TARA||GREENLEY|APRN|Nurse Practitioner|1950 CIR OF HOPE DR|SALT LAKE CITY|UT|84112|8015853229|2024-08-23|2024-10-16
WISE|1326436478|273321637|ANNABELLE LAVENBERG|ANNABELLE||LAVENBERG|BCBA|ABA Therapy|5558 S 1900 W STE B|SALT LAKE CITY|UT|84129|8012555131|2024-09-24|2024-10-16
WISE|1457701518|870281028|LAUREN E VIEIRA|LAUREN|E|VIEIRA|PA-C|Physician Assistant|1055 N 500 W STE 111|PROVO|UT|84604|8014180920|2024-08-16|2024-10-16
WISE|1457701518|870281028|LAUREN E VIEIRA|LAUREN|E|VIEIRA|PA-C|Physician Assistant|220 N 1200 E STE 203|LEHI|UT|84043|8014180920|2024-08-16|2024-10-16
WISE|1477768364|836000025|BRADLEY J DEMARAIS|BRADLEY|J|DEMARAIS|MD|General Surgery|2221 ELM ST|RAWLINS|WY|82301|3073242221|2024-08-28|2024-10-16
WISE|1477768364|836000025|BRADLEY J DEMARAIS|BRADLEY|J|DEMARAIS|MD|General Surgery|2221 ELM ST STE A-1|RAWLINS|WY|82301|3073246022|2024-08-28|2024-10-16
WISE|1477768364|836000025|BRADLEY J DEMARAIS|BRADLEY|J|DEMARAIS|MD|General Surgery|P.O. BOX 460|RAWLINS|WY|82301||2024-08-28|2024-10-16
WISE|1497845010|471497384|THEODORE J PYSHER|THEODORE|J|PYSHER|MD|Pathology|50 N MEDICAL DR|SALT LAKE CITY|UT|84132|8015812507|2024-07-01|2024-10-16
WISE|1497845010|471497384|THEODORE J PYSHER|THEODORE|J|PYSHER|MD|Pathology|500 S CHIPETA WAY|SALT LAKE CITY|UT|84108|8015832787|2024-07-01|2024-10-16
WISE|1497845010|811366784|THEODORE J PYSHER|THEODORE|J|PYSHER|MD|Pathology|100 N MARIO CAPECCHI DR|SALT LAKE CITY|UT|84113|8016622150|2024-07-01|2024-10-16
WISE|1528369055|870566149|AMANDA J RESCHKE|AMANDA|J|RESCHKE|NNP|Nurse Practitioner|1000 E 100 N|PAYSON|UT|84651|8014657000|2024-10-01|2024-10-16
WISE|1528369055|870566149|AMANDA J RESCHKE|AMANDA|J|RESCHKE|NNP|Nurse Practitioner|750 W 800 N|OREM|UT|84057|8017146000|2024-10-01|2024-10-16
WISE|1629675699|870281028|JESSE D BALLARD|JESSE|D|BALLARD|FNP|Family Practice|2183 W MAIN ST STE A107|LEHI|UT|84043|3852031215|2024-09-05|2024-10-16
WISE|1629675699|870281028|JESSE D BALLARD|JESSE|D|BALLARD|FNP|Family Practice|4095 E PONY EXPRESS PKWY STE 1|EAGLE MOUNTAIN|UT|84005|3852031215|2024-09-05|2024-10-16
WISE|1629675699|870281028|JESSE D BALLARD|JESSE|D|BALLARD|FNP|Family Practice|972 N 600 E|SPANISH FORK|UT|84660|3852031215|2024-09-05|2024-10-16
WISE|1649915174|471497384|ALICE E PUGH|ALICE|E|PUGH|OT|Occupational Therapy|417 S WAKARA WAY STE 1410|SALT LAKE CITY|UT|84108|8015856837|2024-09-01|2024-10-16
WISE|1700426228|870281028|ERIN E ROBERTS|ERIN|E|ROBERTS|FNP|Family Practice|2183 W MAIN ST STE A107|LEHI|UT|84043|3852031215|2024-06-10|2024-10-16
WISE|1760942833|471497384|ALLIE M SIMPSON|ALLIE|M|SIMPSON|MD|Ophthalmology|243 E 6100 S|SALT LAKE CITY|UT|84107|8015853937|2024-07-12|2024-10-16
WISE|1760942833|471497384|ALLIE M SIMPSON|ALLIE|M|SIMPSON|MD|Ophthalmology|65 S MARIO CAPECCHI DR|SALT LAKE CITY|UT|84132|8015812352|2024-07-12|2024-10-16
WISE|1851025183|870281028|CAMERON G SEARLE|CAMERON|G|SEARLE|PA|Physician Assistant|1055 N 500 W STE 212|PROVO|UT|84604|3852032720|2024-09-27|2024-10-16
WISE|1851025183|870281028|CAMERON G SEARLE|CAMERON|G|SEARLE|PA|Physician Assistant|555 W STATE ROAD 164|SALEM|UT|84653|3852032720|2024-09-27|2024-10-16
WISE|1851337554|830249708|ROBERT J LOTSTEIN|ROBERT|J|LOTSTEIN|MD|Emergency Medicine|400 S 15TH ST|WORLAND|WY|82401|3073473221|2024-09-01|2024-10-16
WISE|1922096551|836000025|STEVEN K BRANCH|STEVEN|K|BRANCH|MD|General Surgery|2221 ELM ST STE A-1|RAWLINS|WY|82301|3073246022|2024-08-28|2024-10-16
WISE|1922096551|836000025|STEVEN K BRANCH|STEVEN|K|BRANCH|MD|General Surgery|2221 W ELM ST|RAWLINS|WY|82301|3073242221|2024-08-28|2024-10-16
WISE|1932154200|841367175|JARED L BINGHAM|JARED|L|BINGHAM|MD|Family Practice|591 N STATE ROAD 198 STE 202|SALEM|UT|84653|8014659802|2024-10-01|2024-10-16
WISE|1932154200|841367175|JARED L BINGHAM|JARED|L|BINGHAM|MD|Family Practice|94 W MAIN ST|SANTAQUIN|UT|84655|8017543122|2024-10-01|2024-10-16
WISE|1992281398|273321637|CHAYNE WILLITS|CHAYNE||WILLITS|BCBA|ABA Therapy|525 S 850 E STE 6|LEHI|UT|84043|8012555131|2024-09-30|2024-10-16