Provider Demographics
NPI:1396866711
Name:UTT, REBECCA R (RN)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:R
Last Name:UTT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 GAMBELS RD
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505-8618
Mailing Address - Country:US
Mailing Address - Phone:970-241-1329
Mailing Address - Fax:
Practice Address - Street 1:510 29.5 ROAD
Practice Address - Street 2:MESA COUNTY HEALTH DEPARTMENT
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81504
Practice Address - Country:US
Practice Address - Phone:970-254-4102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO51542163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse