Healthcare Provider Details

I. General information

NPI: 1093129173
Provider Name (Legal Business Name): RAYLENE FRANCES NATWICK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2014
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3592 W 9000 S STE 210
WEST JORDAN UT
84088
US

IV. Provider business mailing address

PO BOX 800022
KANSAS CITY MO
64180-0022
US

V. Phone/Fax

Practice location:
  • Phone: 801-208-1050
  • Fax: 801-208-6376
Mailing address:
  • Phone: 800-953-0104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301105559
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number11222369-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: