Provider Demographics
NPI:1235803727
Name:RISE PEDIATRICS PLLC
Entity Type:Organization
Organization Name:RISE PEDIATRICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:HOMER
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:801-930-0776
Mailing Address - Street 1:180 N UNIVERSITY AVE STE 270
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84601-5648
Mailing Address - Country:US
Mailing Address - Phone:801-930-0776
Mailing Address - Fax:385-217-6817
Practice Address - Street 1:180 N UNIVERSITY AVE STE 270
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84601-5648
Practice Address - Country:US
Practice Address - Phone:801-930-0776
Practice Address - Fax:385-217-6817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-06
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty