MEDICARE: MS. SHARON SEELEY R.N.

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	163WP0808X	Psychiatric/Mental Health Registered Nurse	962942403102	UT

General Provider Information

NPI Number	:	1639157662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHARON SEELEY R.N.

Provider Business Mailing Address
First Line	:	4460 HIGHLAND DR
Second Line	:	SUITE #100
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-3543
Country	:	US
Telephone Number	:	801-273-1085
Fax Number	:	801-273-4097

Provider Business Practice Location Address
First Line	:	4460 HIGHLAND DR
Second Line	:	SUITE #100
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-3543
Country	:	US
Telephone Number	:	801-273-1085
Fax Number	:	801-273-4097

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

Provider Enumeration Date	:	01/09/2006
Last Update Date	:	07/08/2007

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