Healthcare Provider Details

I. General information

NPI: 1861241721
Provider Name (Legal Business Name): JASMIN MARIE GURULE DALEY RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JASMIN MARIE FERGUSON RN, BSN

II. Dates (important events)

Enumeration Date: 05/14/2024
Last Update Date: 05/14/2024
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1461 E 100 S UNIT A304
PAYSON UT
84651-3380
US

IV. Provider business mailing address

1461 E 100 S UNIT A304
PAYSON UT
84651-3380
US

V. Phone/Fax

Practice location:
  • Phone: 385-505-0468
  • Fax:
Mailing address:
  • Phone: 385-505-0468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number11279716-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: