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General NPI Number Information
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NPI Number | 1386135762
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Entity Type | Organization
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Legal Business Name | SUNRISE FAMILY PRACTICE LLC
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Dates
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Enumeration Date | 05/22/2018
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Last Update Date | 02/14/2019
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Provider Practice Location Address
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Address Line | 8785 S JORDAN VALLEY WAY # 100
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City | WEST JORDAN
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State | UT
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Zip | 84088-9772
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Country | US
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Telephone | 385-645-7474
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Fax |
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Provider Business Mailing Address
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Address Line | 8785 S JORDAN VALLEY WAY # 100
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City | WEST JORDAN
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State | UT
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Zip | 84088-9772
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOLOLENE ALLAN
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Credential | APRN
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Telephone | 385-645-7474
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 211972-4405
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License Number State | UT
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