Healthcare Provider Details

I. General information

NPI: 1326731308
Provider Name (Legal Business Name): RACHAEL ANNE HUBERTZ APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2023
Last Update Date: 05/26/2023
Certification Date: 05/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5770 S 250 E STE 135
MURRAY UT
84107-8241
US

IV. Provider business mailing address

5770 S 250 E STE 135
MURRAY UT
84107-8241
US

V. Phone/Fax

Practice location:
  • Phone: 801-314-2225
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number9087965-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: