1760526438 NPI number — REBECCA ANN MCINNIS CNM

Table of content: STEVEN B CAIN PHARM D (NPI 1780303222)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760526438 NPI number — REBECCA ANN MCINNIS CNM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCINNIS
Provider First Name:
REBECCA
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CNM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LAURITZEN
Provider Other First Name:
REBECCA
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1760526438
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4555 CREEK LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MURRAY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84107-3913
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-288-0087
Provider Business Mailing Address Fax Number:
801-278-3112

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2180 E 4500 S
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
HOLLADAY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84117-4434
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-278-3102
Provider Business Practice Location Address Fax Number:
801-278-3112
Provider Enumeration Date:
02/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367A00000X , with the licence number:  47473784402 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 72884 . This is a "PEHP INSURANCE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 4747378440001 . This is a "BCBS INSURANCE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".




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