MEDICARE: LINDA JONES ROBERTS APRN

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	363LF0000X	Family Nurse Practitioner	219829-4405	UT

General Provider Information

NPI Number	:	1770760563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA JONES ROBERTS APRN

Provider Business Mailing Address
First Line	:	974 N 1500 E
Second Line	:
City	:	LOGAN
State	:	UT
Zip	:	84321-4355
Country	:	US
Telephone Number	:	435-753-4658
Fax Number	:

Provider Business Practice Location Address
First Line	:	2051 NORTH 600 WEST, CVYC
Second Line	:
City	:	LOGAN
State	:	UT
Zip	:	84321-4355
Country	:	US
Telephone Number	:	435-770-7453
Fax Number	:

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

Provider Enumeration Date	:	01/24/2008
Last Update Date	:	01/24/2008

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