Healthcare Provider Details

I. General information

NPI: 1487569240
Provider Name (Legal Business Name): MRS. NERAK BLU FAVERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 W MAIN ST
VERNAL UT
84078-2535
US

IV. Provider business mailing address

5969 S 1475 E
VERNAL UT
84078-8517
US

V. Phone/Fax

Practice location:
  • Phone: 435-790-5628
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: