MEDICARE: MRS. BEVERLY ANN HALL FNP-C

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	7670881-4405	UT

General Provider Information

NPI Number	:	1558334979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BEVERLY ANN HALL FNP-C

Provider Business Mailing Address
First Line	:	576 W 900 S STE 250
Second Line	:
City	:	WOODS CROSS
State	:	UT
Zip	:	84010-8177
Country	:	US
Telephone Number	:	801-397-4000
Fax Number	:

Provider Business Practice Location Address
First Line	:	118 N SUN ARBOR TER APT 2015
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84116-4503
Country	:	US
Telephone Number	:	84-109-4402
Fax Number	:

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

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	06/29/2020

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