MEDICARE: MERLE LAWTER 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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	11135223-4405	UT
2	364SP0808X	Psychiatric/Mental Health Clinical Nurse Specialist	11135223-8900	UT

General Provider Information

NPI Number	:	1518680214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MERLE LAWTER APRN

Provider Business Mailing Address
First Line	:	437 S BLUFF ST STE 302
Second Line	:
City	:	SAINT GEORGE
State	:	UT
Zip	:	84770-3591
Country	:	US
Telephone Number	:	435-634-8848
Fax Number	:	435-634-8884

Provider Business Practice Location Address
First Line	:	437 S BLUFF ST STE 302
Second Line	:
City	:	SAINT GEORGE
State	:	UT
Zip	:	84770-3591
Country	:	US
Telephone Number	:	435-634-8848
Fax Number	:	435-634-8884

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

Provider Enumeration Date	:	09/19/2022
Last Update Date	:	04/17/2024

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