Healthcare Provider Details

I. General information

NPI: 1396941506
Provider Name (Legal Business Name): PAMELA TANNER-MURAY R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

471 S MAIN ST STE 4
MOAB UT
84532-2980
US

IV. Provider business mailing address

PO BOX E
MOAB UT
84532-1127
US

V. Phone/Fax

Practice location:
  • Phone: 435-259-5602
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP1700X
TaxonomyPerinatal Registered Nurse
License Number193595-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: