MEDICARE: SPECIALTY NURSING SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory	46D0925016	UT
2	251E00000X	Home Health Agency	2004-HHA-844	UT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	467110	OTHER		MEDICARE OSCAR NUMBER

General Provider Information

NPI Number	:	1144223249
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECIALTY NURSING SERVICES

Provider Business Mailing Address
First Line	:	620 S 9500 E
Second Line	:
City	:	HUNTSVILLE
State	:	UT
Zip	:	84317
Country	:	US
Telephone Number	:	801-732-2178
Fax Number	:	801-732-2173

Provider Business Practice Location Address
First Line	:	620 S 9500 E
Second Line	:
City	:	HUNTSVILLE
State	:	UT
Zip	:	84317
Country	:	US
Telephone Number	:	801-732-2178
Fax Number	:	801-732-2173

Authorized Official
Title or Position	:	OFFLCE MANAGER
Name	:	TAWSHAWNI BUTCHER
Credential	:
Telephone Number	:	801-732-2168

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	02/29/2024

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Directions to “SPECIALTY NURSING SERVICES ” Practice Location

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