Healthcare Provider Details

I. General information

NPI: 1700337631
Provider Name (Legal Business Name): LIVING WELL PATIENT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2016
Last Update Date: 10/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 W 5600 S
ROY UT
84067-1372
US

IV. Provider business mailing address

2700 W 5600 S
ROY UT
84067-1372
US

V. Phone/Fax

Practice location:
  • Phone: 801-388-2189
  • Fax:
Mailing address:
  • Phone: 801-388-2189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number2015004405
License Number StateUT

VIII. Authorized Official

Name: MRS. KIM I BEUS
Title or Position: NURSE PRACTITIONER
Credential: APRN
Phone: 801-388-2189