=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578367793
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LARAMIE RACHEL ALLRED RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/04/2025
-----------------------------------------------------
Last Update Date | 04/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1251 NORTHFIELD RD STE 105
-----------------------------------------------------
City | CEDAR CITY
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84721-8622
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 435-263-0267
-----------------------------------------------------
Fax | 435-867-1472
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5165 N 2475 W
-----------------------------------------------------
City | CEDAR CITY
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84721-8828
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 435-219-3412
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 12503352-3102
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------