MEDICARE: MRS. ROSE B OLDS 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	364SP0808X	Psychiatric/Mental Health Clinical Nurse Specialist	2152474405	UT

General Provider Information

NPI Number	:	1619927795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ROSE B OLDS APRN

Provider Business Mailing Address
First Line	:	370 E SOUTH TEMPLE
Second Line	:	STE 550
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84111-1206
Country	:	US
Telephone Number	:	801-537-7070
Fax Number	:	801-355-9322

Provider Business Practice Location Address
First Line	:	370 E SOUTH TEMPLE
Second Line	:	STE 550
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84111-1206
Country	:	US
Telephone Number	:	801-537-7070
Fax Number	:	801-355-9322

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

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	07/08/2007

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