Healthcare Provider Details

I. General information

NPI: 1073232716
Provider Name (Legal Business Name): CIERRA JANE MANLEY RANGEL FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2022
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 MEDICAL DR
BRIGHAM CITY UT
84302-3284
US

IV. Provider business mailing address

PO BOX 100253
ATLANTA GA
30384-0253
US

V. Phone/Fax

Practice location:
  • Phone: 435-734-4280
  • Fax: 435-734-4281
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number10325782-3102
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number13043794-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: