Healthcare Provider Details

I. General information

NPI: 1952171340
Provider Name (Legal Business Name): RAELIN ATKINSON BC-HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2024
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 E 4500 S STE 110
MURRAY UT
84107-4224
US

IV. Provider business mailing address

310 E 4500 S STE 110
MURRAY UT
84107-4224
US

V. Phone/Fax

Practice location:
  • Phone: 801-486-9309
  • Fax:
Mailing address:
  • Phone: 801-486-9309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number12066849-4601
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: