Healthcare Provider Details

I. General information

NPI: 1578494977
Provider Name (Legal Business Name): REBEKAH ELIZABETH ULRICH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1745 W 2770 S
SYRACUSE UT
84075-3939
US

IV. Provider business mailing address

1745 W 2770 S
SYRACUSE UT
84075-3939
US

V. Phone/Fax

Practice location:
  • Phone: 801-663-9137
  • Fax: 801-663-9137
Mailing address:
  • Phone: 801-663-9137
  • Fax: 801-663-9137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number10806029-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: