Healthcare Provider Details

I. General information

NPI: 1912374521
Provider Name (Legal Business Name): CINDY CLYMORE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2015
Last Update Date: 08/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5770 S 250 E
MURRAY UT
84107-8100
US

IV. Provider business mailing address

5770 S 250 E
MURRAY UT
84107-8100
US

V. Phone/Fax

Practice location:
  • Phone: 801-314-4500
  • Fax:
Mailing address:
  • Phone: 801-314-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number6424783-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: