Healthcare Provider Details

I. General information

NPI: 1619372844
Provider Name (Legal Business Name): AUDRA MORLAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2014
Last Update Date: 10/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

281 E 200 N
ROOSEVELT UT
84066-2343
US

IV. Provider business mailing address

281 E 200 N
ROOSEVELT UT
84066-2343
US

V. Phone/Fax

Practice location:
  • Phone: 435-722-6300
  • Fax: 435-722-6301
Mailing address:
  • Phone: 435-722-6300
  • Fax: 435-722-6301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number367452-3102
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number367452-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: