MEDICARE: MS. MAXINE MARIE SABIN RN

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	1892413102	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	107030145101	OTHER	UT	IHC
2	262123	OTHER	UT	DESERT MUTUAL
3	942938348SA1	OTHER	UT	EDUCATORS MUTUAL

General Provider Information

NPI Number	:	1720061286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MAXINE MARIE SABIN RN

Provider Business Mailing Address
First Line	:	1703 HERBERT AVE
Second Line	:
City	:	SLC
State	:	UT
Zip	:	84108-1829
Country	:	US
Telephone Number	:	801-583-8929
Fax Number	:

Provider Business Practice Location Address
First Line	:	1141 E 3900 S
Second Line	:	STE A-250
City	:	SLC
State	:	UT
Zip	:	84124-1215
Country	:	US
Telephone Number	:	801-284-4903
Fax Number	:	801-284-4901

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

Provider Enumeration Date	:	11/29/2005
Last Update Date	:	04/12/2012

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