MEDICARE: ERIN MARIE MERRYWEATHER 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	363LF0000X	Family Nurse Practitioner	351266-4405	UT

General Provider Information

NPI Number	:	1548278658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN MARIE MERRYWEATHER NP

Provider Business Mailing Address
First Line	:	783 E 530 N
Second Line	:
City	:	HEBER CITY
State	:	UT
Zip	:	84032-3021
Country	:	US
Telephone Number	:	435-654-2019
Fax Number	:

Provider Business Practice Location Address
First Line	:	807 E SOUTH TEMPLE
Second Line	:	STE 101
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-1339
Country	:	US
Telephone Number	:	801-746-0776
Fax Number	:

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

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	05/03/2016

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