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General NPI Number Information
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NPI Number | 1275348807
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Entity Type | Organization
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Legal Business Name | MOONLIT
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Dates
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Enumeration Date | 02/11/2025
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Last Update Date | 02/11/2025
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Provider Practice Location Address
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Address Line | 6211 S HIGHLAND DR # 4025
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City | HOLLADAY
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State | UT
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Zip | 84121-2125
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Country | US
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Telephone | 385-246-2522
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Fax | 801-581-5604
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Provider Business Mailing Address
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Address Line | 6211 S HIGHLAND DR # 4025
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City | HOLLADAY
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State | UT
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Zip | 84121-2125
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Country | US
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Telephone | 385-246-2522
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Fax | 801-581-5604
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Authorized Official
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Title or Position | RESIDENT PSYCHIATRIST
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Name | CHRISTOPHER RUFUS SWEENEY
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Credential | MD
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Telephone | 801-581-7951
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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