Provider Demographics
NPI:1346525474
Name:RALSTON, ROBERT WILSON (FNP-C)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:WILSON
Last Name:RALSTON
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 N 980 W
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-7709
Mailing Address - Country:US
Mailing Address - Phone:801-724-4000
Mailing Address - Fax:801-724-4001
Practice Address - Street 1:830 N 980 W
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-7709
Practice Address - Country:US
Practice Address - Phone:801-724-4000
Practice Address - Fax:801-724-4001
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6329438-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily