Healthcare Provider Details

I. General information

NPI: 1326856428
Provider Name (Legal Business Name): JUNIPER REJUVENATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2024
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1028 N CHUSI WAY
IVINS UT
84738-6722
US

IV. Provider business mailing address

1028 N CHUSI WAY
IVINS UT
84738-6722
US

V. Phone/Fax

Practice location:
  • Phone: 410-598-4165
  • Fax:
Mailing address:
  • Phone: 410-598-4165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROSANNE T CALURE
Title or Position: NURSE PRACTITIONER
Credential: NP
Phone: 410-598-4165