MEDICARE: ELIZABETH N DREW

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	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1386033397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH N DREW

Provider Business Mailing Address
First Line	:	10047 N SAGE RD E
Second Line	:
City	:	CEDAR HILLS
State	:	UT
Zip	:	84062-9636
Country	:	US
Telephone Number	:	801-796-1151
Fax Number	:

Provider Business Practice Location Address
First Line	:	10047 N SAGE RD E
Second Line	:
City	:	CEDAR HILLS
State	:	UT
Zip	:	84062-9636
Country	:	US
Telephone Number	:	801-796-1151
Fax Number	:

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

Provider Enumeration Date	:	01/14/2015
Last Update Date	:	01/14/2015

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