Provider Demographics
NPI:1679174346
Name:FELL, CORDALYNN
Entity Type:Individual
Prefix:MISS
First Name:CORDALYNN
Middle Name:
Last Name:FELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:
Other - Last Name:FELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4431 S HONEYWOOD LN
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84120-5845
Mailing Address - Country:US
Mailing Address - Phone:530-718-9304
Mailing Address - Fax:
Practice Address - Street 1:4431 S HONEYWOOD LN
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84120-5845
Practice Address - Country:US
Practice Address - Phone:530-718-9304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-07
Last Update Date:2020-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider