MEDICARE: KATHERINE ROUSE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1215743950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE ROUSE

Provider Business Mailing Address
First Line	:	2162 S 180 E
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84606-7370
Country	:	US
Telephone Number	:	385-378-5201
Fax Number	:

Provider Business Practice Location Address
First Line	:	2162 S 180 E
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84606-7370
Country	:	US
Telephone Number	:	385-378-5201
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/07/2024
Last Update Date	:	12/11/2024

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Directions to “ KATHERINE ROUSE ” Practice Location

Language	Start Address	Practice Location

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