Healthcare Provider Details

I. General information

NPI: 1770659930
Provider Name (Legal Business Name): JANE L YORK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BETTY JANE YORK RN

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 S UNIVERSITY AVE # 1900
PROVO UT
84601-4427
US

IV. Provider business mailing address

185 E 400 N
PAYSON UT
84651-1844
US

V. Phone/Fax

Practice location:
  • Phone: 801-851-7049
  • Fax: 801-343-8724
Mailing address:
  • Phone: 801-465-4110
  • Fax: 801-465-4110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number218049-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: