MEDICARE: JANIS M POPE APRN

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	163W00000X	Registered Nurse	220322-4405	UT

General Provider Information

NPI Number	:	1326267972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANIS M POPE APRN

Provider Business Mailing Address
First Line	:	PO BOX 307
Second Line	:
City	:	BOUNTIFUL
State	:	UT
Zip	:	84011-0307
Country	:	US
Telephone Number	:	801-294-6907
Fax Number	:	801-294-6917

Provider Business Practice Location Address
First Line	:	2773 ETIENNE WAY
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84093-1116
Country	:	US
Telephone Number	:	801-272-0255
Fax Number	:	801-272-0183

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	09/21/2010

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