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General NPI Number Information
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NPI Number | 1891388674
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Entity Type | Individual
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Provider Name | ALLYSON WHITE RUCKER NP
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Gender | Female
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Dates
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Enumeration Date | 02/12/2021
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Last Update Date | 02/12/2021
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Provider Practice Location Address
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Address Line | 415 MEDICAL DR STE B200
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City | BOUNTIFUL
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State | UT
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Zip | 84010-4986
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Country | US
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Telephone | 801-295-9105
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Fax |
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Provider Business Mailing Address
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Address Line | 1010 W CYAN VALLEY WAY
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City | BLUFFDALE
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State | UT
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Zip | 84065-1699
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Country | US
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Telephone | 801-309-0245
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 8003670-4405
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License Number State | UT
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