MEDICARE: MEGAN WILMARTH RN

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	163WC0200X	Critical Care Medicine Registered Nurse	10840037-3102	UT
2	163WL0100X	Lactation Consultant (Registered Nurse)	10840037-3102	UT
3	163WN0002X	Neonatal Intensive Care Registered Nurse	10840037-3102	UT
4	163W00000X	Registered Nurse	10840037-3102	UT

General Provider Information

NPI Number	:	1568283067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN WILMARTH RN

Provider Business Mailing Address
First Line	:	1622 E 560 S
Second Line	:
City	:	HEBER CITY
State	:	UT
Zip	:	84032-3300
Country	:	US
Telephone Number	:	805-630-7371
Fax Number	:

Provider Business Practice Location Address
First Line	:	1622 E 560 S
Second Line	:
City	:	HEBER CITY
State	:	UT
Zip	:	84032-3300
Country	:	US
Telephone Number	:	805-630-7371
Fax Number	:

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

Provider Enumeration Date	:	10/18/2024
Last Update Date	:	10/18/2024

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