Provider Demographics
NPI:1275223067
Name:BESSER, MICAELA JOY
Entity Type:Individual
Prefix:
First Name:MICAELA
Middle Name:JOY
Last Name:BESSER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:739 S 300 W UNIT 312
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84101-2623
Mailing Address - Country:US
Mailing Address - Phone:502-542-2133
Mailing Address - Fax:
Practice Address - Street 1:10 S 2000 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84112-5880
Practice Address - Country:US
Practice Address - Phone:502-542-2133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13026938-3102163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse