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NPI Code Detail

MEDICARE: REBEKAH LYNN GARDNER MSWI

MEDICARE: REBEKAH LYNN GARDNER MSWI
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1356020754
Entity Type Code : Individual
Provider Name (Legal Business Name) : REBEKAH LYNN GARDNER MSWI
Provider Business Mailing Address
First Line : 2057 E GLACIER VIEW DR
Second Line :
City : SANDY
State : UT
Zip : 84092-6700
Country : US
Telephone Number : 801-471-4116
Fax Number :
Provider Business Practice Location Address
First Line : 3002 W 12600 S
Second Line :
City : RIVERTON
State : UT
Zip : 84065-7119
Country : US
Telephone Number : 801-930-0411
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2023
Last Update Date : 07/13/2023

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