MEDICARE: REBECCA ANNE PATTON DNP, RN, NNP-BC

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	363L00000X	Nurse Practitioner	9427887-4405	UT
2	363LN0005X	Critical Care Neonatal Nurse Practitioner	.	UT

General Provider Information

NPI Number	:	1437911708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA ANNE PATTON DNP, RN, NNP-BC

Provider Business Mailing Address
First Line	:	1459 S AMBASSADOR WAY
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-2858
Country	:	US
Telephone Number	:	801-915-2168
Fax Number	:

Provider Business Practice Location Address
First Line	:	1459 S AMBASSADOR WAY
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-2858
Country	:	US
Telephone Number	:	801-915-2168
Fax Number	:

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

Provider Enumeration Date	:	01/23/2024
Last Update Date	:	09/11/2024

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