MEDICARE: MS. DEBRA J MERCY NP

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	363L00000X	Nurse Practitioner	NP-277A	ID

General Provider Information

NPI Number	:	1528106325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEBRA J MERCY NP

Provider Business Mailing Address
First Line	:	26 N 1900 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84132-0002
Country	:	US
Telephone Number	:	801-587-5859
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 N MEDICAL DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84132-4881
Country	:	US
Telephone Number	:	801-587-5859
Fax Number	:

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

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	11/22/2021

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