Healthcare Provider Details

I. General information

NPI: 1346434453
Provider Name (Legal Business Name): BONNEVILLE HEALTH RECRUITERS DBA PROFESSIONAL NURSING SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2007
Last Update Date: 08/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1196 W SOUTH JORDAN PKWY SUITE C
SOUTH JORDAN UT
84095-4603
US

IV. Provider business mailing address

1196 W SOUTH JORDAN PKWY SUITE C
SOUTH JORDAN UT
84095-4603
US

V. Phone/Fax

Practice location:
  • Phone: 801-446-4545
  • Fax: 801-446-4499
Mailing address:
  • Phone: 801-446-4545
  • Fax: 801-446-4499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. VERA P ANDRUS
Title or Position: V.P.
Credential:
Phone: 801-446-4545