Provider Demographics
NPI:1033351416
Name:HOWLETT, MICHAEL WALLACE (RN)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:WALLACE
Last Name:HOWLETT
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3015 SUNDRIFT CIR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-4349
Mailing Address - Country:US
Mailing Address - Phone:801-942-5515
Mailing Address - Fax:
Practice Address - Street 1:3015 SUNDRIFT CIR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-4349
Practice Address - Country:US
Practice Address - Phone:801-942-5515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-31
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT204505-3102163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy