Healthcare Provider Details

I. General information

NPI: 1316133663
Provider Name (Legal Business Name): TAMARA JEAN SASSER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TAMARA JEAN WARD

II. Dates (important events)

Enumeration Date: 09/20/2007
Last Update Date: 09/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3753 GULLANE RD
EAGLE MOUNTAIN UT
84005-5154
US

IV. Provider business mailing address

3753 GULLANE RD
EAGLE MOUNTAIN UT
84005-5154
US

V. Phone/Fax

Practice location:
  • Phone: 801-616-3583
  • Fax:
Mailing address:
  • Phone: 801-616-3583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: