Healthcare Provider Details

I. General information

NPI: 1245754878
Provider Name (Legal Business Name): REBECCA VAILLANCOURT SWAIN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2017
Last Update Date: 07/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 S 900 E
SALT LAKE CITY UT
84105-3208
US

IV. Provider business mailing address

676 N 2750 W
WEST POINT UT
84015-7839
US

V. Phone/Fax

Practice location:
  • Phone: 801-464-7500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7995957-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: