Healthcare Provider Details

I. General information

NPI: 1275468142
Provider Name (Legal Business Name): TAYLOR M RODEBACK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4432 W 10000 S
PAYSON UT
84651-9704
US

IV. Provider business mailing address

4432 W 10000 S
PAYSON UT
84651-9704
US

V. Phone/Fax

Practice location:
  • Phone: 801-615-9412
  • Fax:
Mailing address:
  • Phone: 801-615-9412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: