Provider Demographics
NPI:1639759103
Name:CHADOR, REBECCA CLAIRE
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:CLAIRE
Last Name:CHADOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RILEY
Other - Middle Name:
Other - Last Name:CHADOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:801-285-4543
Mailing Address - Fax:
Practice Address - Street 1:3723 W 12600 S STE 450
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-7296
Practice Address - Country:US
Practice Address - Phone:801-285-4543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-09
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10634649-4405363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics