Healthcare Provider Details

I. General information

NPI: 1699021741
Provider Name (Legal Business Name): LESLIE POLLIO FARRELL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2012
Last Update Date: 07/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5770 S 250 E STE 330
MURRAY UT
84107-8100
US

IV. Provider business mailing address

5770 S 250 E STE 330
MURRAY UT
84107-8100
US

V. Phone/Fax

Practice location:
  • Phone: 801-314-4455
  • Fax: 801-314-4433
Mailing address:
  • Phone: 801-314-4455
  • Fax: 801-314-4433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number60267774405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: