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General NPI Number Information
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NPI Number | 1821814930
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Entity Type | Organization
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Legal Business Name | GRAND VALLEY PSYCHIATRY
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Dates
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Enumeration Date | 11/23/2024
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Last Update Date | 11/23/2024
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Provider Practice Location Address
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Address Line | 2639 W 13220 S
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City | RIVERTON
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State | UT
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Zip | 84065-2279
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Country | US
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Telephone | 801-815-2068
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Fax | 610-850-6778
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Provider Business Mailing Address
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Address Line | 2639 W 13220 S
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City | RIVERTON
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State | UT
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Zip | 84065-2279
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Country | US
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Telephone | 801-815-2068
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Fax | 610-850-6778
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Authorized Official
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Title or Position | OWNER
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Name | MAURICE FIEDEL
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Credential | APRN
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Telephone | 801-815-2068
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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