Healthcare Provider Details

I. General information

NPI: 1033351416
Provider Name (Legal Business Name): MICHAEL WALLACE HOWLETT RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2009
Last Update Date: 03/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3015 SUNDRIFT CIR
SALT LAKE CITY UT
84121-4349
US

IV. Provider business mailing address

3015 SUNDRIFT CIR
SALT LAKE CITY UT
84121-4349
US

V. Phone/Fax

Practice location:
  • Phone: 801-942-5515
  • Fax:
Mailing address:
  • Phone: 801-942-5515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number204505-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: