Healthcare Provider Details

I. General information

NPI: 1528676509
Provider Name (Legal Business Name): MELANIE NICOLE EMMERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2020
Last Update Date: 12/03/2022
Certification Date: 12/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5121 S COTTONWOOD ST
MURRAY UT
84107-5701
US

IV. Provider business mailing address

380 S 400 E APT 603
SALT LAKE CITY UT
84111-2942
US

V. Phone/Fax

Practice location:
  • Phone: 801-696-0077
  • Fax:
Mailing address:
  • Phone: 801-696-0077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number11831288-3602
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: