Provider Demographics
NPI:1265035257
Name:FIEDEL, MAURICE MANFRED (APRN)
Entity Type:Individual
Prefix:
First Name:MAURICE
Middle Name:MANFRED
Last Name:FIEDEL
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2639 W 13220 S
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-2279
Mailing Address - Country:US
Mailing Address - Phone:801-815-2068
Mailing Address - Fax:
Practice Address - Street 1:2639 W 13220 S
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-2279
Practice Address - Country:US
Practice Address - Phone:801-815-2068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-20
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6210942-3102163WP0808X
UT6210942-4405363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health