Healthcare Provider Details

I. General information

NPI: 1588191076
Provider Name (Legal Business Name): ALYSSA MCBRIDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2017
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5121 S COTTONWOOD ST
MURRAY UT
84107-5701
US

IV. Provider business mailing address

12058 S WINDOW ARCH LN
HERRIMAN UT
84096-5822
US

V. Phone/Fax

Practice location:
  • Phone: 801-507-7673
  • Fax:
Mailing address:
  • Phone: 801-691-4906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number8515462-3102
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number8515462-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: