Healthcare Provider Details

I. General information

NPI: 1740698174
Provider Name (Legal Business Name): MELISSA SLAUGH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2014
Last Update Date: 02/03/2023
Certification Date: 02/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 W 500 S
VERNAL UT
84078-2914
US

IV. Provider business mailing address

1140 W 500 S STE 9
VERNAL UT
84078-2912
US

V. Phone/Fax

Practice location:
  • Phone: 435-789-6300
  • Fax: 435-725-6325
Mailing address:
  • Phone: 435-789-6300
  • Fax: 435-725-6325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number7225362-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number7225362-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: