Individual
MR. RONALD GEORGE MORTENSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
QMRP/TRS
Contact information
Practice address
1367 N 550 E, NEPHI, UT 84648-2213
(435) 623-0140
(435) 623-2627
Mailing address
1367 N 550 E, NEPHI, UT 84648-2213
(435) 623-0140
(435) 623-2627
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
7830935
UT
Other
Enumeration date
10/11/2006
Last updated
07/08/2007
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