Individual
MIKALA FAIRBANKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
638 N 450 W, OREM, UT 84057-3794
(801) 373-4760
Mailing address
638 N 450 W, OREM, UT 84057-3794
(801) 717-6027
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
178234323
UT
Other
Enumeration date
08/19/2016
Last updated
08/19/2016
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