Healthcare Provider Details

I. General information

NPI: 1285084525
Provider Name (Legal Business Name): MORGAN CHARLES GALBRAITH A.P.R.N.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2016
Last Update Date: 06/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

813 E 200 S # 1
SALT LAKE CITY UT
84102-2304
US

IV. Provider business mailing address

813 E 200 S # 1
SALT LAKE CITY UT
84102-2304
US

V. Phone/Fax

Practice location:
  • Phone: 801-505-1209
  • Fax:
Mailing address:
  • Phone: 801-505-1209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7587493-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: