MEDICARE: MRS. MALORIE REBEKAH CARTER

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	171M00000X	Case Manager/Care Coordinator
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1952888653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MALORIE REBEKAH CARTER

Provider Business Mailing Address
First Line	:	27 S MARIO CAPECCHI DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84112-5888
Country	:	US
Telephone Number	:	801-581-7498
Fax Number	:

Provider Business Practice Location Address
First Line	:	27 S MARIO CAPECCHI DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84112-5888
Country	:	US
Telephone Number	:	801-581-7498
Fax Number	:

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

Provider Enumeration Date	:	07/25/2018
Last Update Date	:	02/27/2023

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