Healthcare Provider Details

I. General information

NPI: 1033887195
Provider Name (Legal Business Name): MICHAEL S ORTON APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2021
Last Update Date: 09/02/2021
Certification Date: 08/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5444 S GREEN ST
MURRAY UT
84123-5632
US

IV. Provider business mailing address

5444 S GREEN ST
MURRAY UT
84123-5632
US

V. Phone/Fax

Practice location:
  • Phone: 801-313-4118
  • Fax: 801-313-4128
Mailing address:
  • Phone: 801-313-4118
  • Fax: 801-313-4128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number12433563-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: