Healthcare Provider Details

I. General information

NPI: 1144290065
Provider Name (Legal Business Name): WENDY FLETCHER WOODBURY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1363 N 200 W
CENTERVILLE UT
84014-1194
US

IV. Provider business mailing address

1363 N 200 W
CENTERVILLE UT
84014-1194
US

V. Phone/Fax

Practice location:
  • Phone: 801-295-5832
  • Fax:
Mailing address:
  • Phone: 801-295-5832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number2153023102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: