Healthcare Provider Details

I. General information

NPI: 1598890618
Provider Name (Legal Business Name): KAREN DELANGE R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 SOUTH 100 WEST
JUNCTION UT
84740
US

IV. Provider business mailing address

PO BOX 440217
KOOSHAREM UT
84744-0217
US

V. Phone/Fax

Practice location:
  • Phone: 435-577-2521
  • Fax: 435-577-2521
Mailing address:
  • Phone: 435-577-2521
  • Fax: 435-577-2521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number178969-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: