Healthcare Provider Details

I. General information

NPI: 1861721086
Provider Name (Legal Business Name): DONNA LUCILLE FERRELL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2009
Last Update Date: 08/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5770 S 250 E STE 340 INTERMOUNTAIN SLEEP DISORDERS
MURRAY UT
84107-8163
US

IV. Provider business mailing address

5770 S 250 E STE 340 INTERMOUNTAIN SLEEP DISORDERS
MURRAY UT
84107-8163
US

V. Phone/Fax

Practice location:
  • Phone: 801-314-2400
  • Fax: 801-314-2385
Mailing address:
  • Phone: 801-314-2400
  • Fax: 801-314-2385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number374720-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: