Healthcare Provider Details

I. General information

NPI: 1457716219
Provider Name (Legal Business Name): SHERYL MCLEAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2015
Last Update Date: 12/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 N UNIVERSITY AVE
PROVO UT
84604-5504
US

IV. Provider business mailing address

1353 SIERRA VIEW DR
MAPLETON UT
84664-5586
US

V. Phone/Fax

Practice location:
  • Phone: 801-932-2591
  • Fax: 801-227-2014
Mailing address:
  • Phone: 801-830-3928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number159744-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: