Healthcare Provider Details

I. General information

NPI: 1396155073
Provider Name (Legal Business Name): TARA LYNN GLEAVE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TARA LYNN GLEAVE RN

II. Dates (important events)

Enumeration Date: 05/02/2014
Last Update Date: 05/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1472 E 820 N
OREM UT
84097-5481
US

IV. Provider business mailing address

1472 EAST 820 NORTH
OREM UT
84097
US

V. Phone/Fax

Practice location:
  • Phone: 801-226-1227
  • Fax: 801-226-1237
Mailing address:
  • Phone: 801-226-1227
  • Fax: 801-226-1237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number357644-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: