Healthcare Provider Details

I. General information

NPI: 1720061286
Provider Name (Legal Business Name): MAXINE MARIE SABIN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 04/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1141 E 3900 S STE A-250
SLC UT
84124-1215
US

IV. Provider business mailing address

1703 HERBERT AVE
SLC UT
84108-1829
US

V. Phone/Fax

Practice location:
  • Phone: 801-284-4903
  • Fax: 801-284-4901
Mailing address:
  • Phone: 801-583-8929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number1892413102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: