Individual
FLORENCE FAIRBANKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
5770 S 1500 W, TAYLORSVILLE, UT 84123-5216
(801) 265-3144
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
(801) 265-3144
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
2103544405
UT
Other
Enumeration date
07/17/2006
Last updated
07/08/2007
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