MEDICARE: MARY SUE STRICKLAND 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	163WG0000X	General Practice Registered Nurse	205855-3102	UT

General Provider Information

NPI Number	:	1902600612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY SUE STRICKLAND RN

Provider Business Mailing Address
First Line	:	1890 S 3850 W STE 220
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84104-4939
Country	:	US
Telephone Number	:	385-549-1121
Fax Number	:

Provider Business Practice Location Address
First Line	:	1890 S 3850 W STE 220
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84104-4939
Country	:	US
Telephone Number	:	385-549-1121
Fax Number	:

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

Provider Enumeration Date	:	04/02/2025
Last Update Date	:	04/02/2025

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