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NPI Code Detail

MEDICARE: MOLLIE MATILDA WHITE RN

MEDICARE: MOLLIE MATILDA WHITE RN
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
1163W00000XRegistered Nurse10409723-3102UT

General Provider Information

NPI Number : 1427146067
Entity Type Code : Individual
Provider Name (Legal Business Name) : MOLLIE MATILDA WHITE RN
Provider Business Mailing Address
First Line : PO BOX 572070
Second Line :
City : MURRAY
State : UT
Zip : 84157-2070
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3809 W 6200 S
Second Line :
City : TAYLORSVILLE
State : UT
Zip : 84129-3725
Country : US
Telephone Number : 888-949-4864
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2006
Last Update Date : 11/15/2018

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