Healthcare Provider Details

I. General information

NPI: 1326799636
Provider Name (Legal Business Name): SPECIALIZED NURSING SERVICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2022
Last Update Date: 01/18/2022
Certification Date: 01/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

689 W 6300 S
MURRAY UT
84123-6846
US

IV. Provider business mailing address

689 W 6300 S
MURRAY UT
84123-6846
US

V. Phone/Fax

Practice location:
  • Phone: 801-450-7122
  • Fax: 801-327-2070
Mailing address:
  • Phone: 801-450-7122
  • Fax: 801-327-2070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: WENDY SUSAETA
Title or Position: OWNER/RN
Credential:
Phone: 801-450-7122