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NPI Code Detail

MEDICARE: STACY K ROBISON APRN

MEDICARE: STACY K ROBISON 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
1363L00000XNurse Practitioner199062-4405UT

General Provider Information

NPI Number : 1346271798
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACY K ROBISON APRN
Provider Business Mailing Address
First Line : 1258 W SOUTH JORDAN PKWY STE 202
Second Line :
City : SOUTH JORDAN
State : UT
Zip : 84095-4712
Country : US
Telephone Number : 801-255-1155
Fax Number : 801-255-0281
Provider Business Practice Location Address
First Line : 1258 W SOUTH JORDAN PKWY STE 202
Second Line :
City : SOUTH JORDAN
State : UT
Zip : 84095-4712
Country : US
Telephone Number : 801-255-1155
Fax Number : 801-255-0281
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2006
Last Update Date : 05/23/2011

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