Provider Demographics
NPI:1134911860
Name:KANAB HEALTHCARE
Entity type:Organization
Organization Name:KANAB HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:GLAZIER
Authorized Official - Last Name:BLASDELL
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:435-644-5626
Mailing Address - Street 1:329 S 350 E STE 4
Mailing Address - Street 2:
Mailing Address - City:KANAB
Mailing Address - State:UT
Mailing Address - Zip Code:84741-3768
Mailing Address - Country:US
Mailing Address - Phone:435-644-5626
Mailing Address - Fax:
Practice Address - Street 1:329 S 350 E STE 4
Practice Address - Street 2:
Practice Address - City:KANAB
Practice Address - State:UT
Practice Address - Zip Code:84741-3768
Practice Address - Country:US
Practice Address - Phone:435-899-0892
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine