MEDICARE: MRS. MARITZA SILVA ARCE-LARRETA APRN, MSN, 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	363LA2200X	Adult Health Nurse Practitioner	199735-4405	UT

General Provider Information

NPI Number	:	1952547408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARITZA SILVA ARCE-LARRETA APRN, MSN, RN

Provider Business Mailing Address
First Line	:	PO BOX 142107
Second Line	:	288 N 1460 W
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84114-2107
Country	:	US
Telephone Number	:	801-538-6990
Fax Number	:	801-538-9495

Provider Business Practice Location Address
First Line	:	288 N 1460 W
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84114-2107
Country	:	US
Telephone Number	:	801-538-6990
Fax Number	:	801-538-9495

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

Provider Enumeration Date	:	01/05/2009
Last Update Date	:	01/05/2009

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