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General NPI Number Information
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NPI Number | 1932911120
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Entity Type | Individual
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Provider Name | TAWNYA LEE RAY WHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 01/23/2025
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Last Update Date | 01/23/2025
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Provider Practice Location Address
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Address Line | 494 S MAIN ST STE 230
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City | HEBER CITY
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State | UT
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Zip | 84032-2241
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Country | US
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Telephone | 801-673-6809
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Fax |
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Provider Business Mailing Address
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Address Line | 916 COBBLESTONE DR
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City | HEBER CITY
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State | UT
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Zip | 84032-3974
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Country | US
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Telephone | 435-339-4747
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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 | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 335646-3102
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License Number State | UT
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