MEDICARE: REBECCA HARRISON 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	363L00000X	Nurse Practitioner	5497556-4405	UT

General Provider Information

NPI Number	:	1942788807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA HARRISON NP

Provider Business Mailing Address
First Line	:	395 W COUGAR BLVD STE 101
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84604-3334
Country	:	US
Telephone Number	:	801-357-7850
Fax Number	:

Provider Business Practice Location Address
First Line	:	395 E COUGAR BLVD
Second Line	:	101
City	:	PROVO
State	:	UT
Zip	:	84604-8460
Country	:	US
Telephone Number	:	801-357-7850
Fax Number	:

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

Provider Enumeration Date	:	08/02/2018
Last Update Date	:	03/11/2021

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