Healthcare Provider Details

I. General information

NPI: 1215971791
Provider Name (Legal Business Name): MELEECE WINWARD HANSEN LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 04/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 W UNIVERSITY BLVD
CEDAR CITY UT
84720-2470
US

IV. Provider business mailing address

351 W UNIVERSITY BLVD
CEDAR CITY UT
84720-2415
US

V. Phone/Fax

Practice location:
  • Phone: 435-559-2104
  • Fax:
Mailing address:
  • Phone: 435-586-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: