Provider Demographics
NPI:1689954505
Name:ORME, RAELEEN (APRN)
Entity Type:Individual
Prefix:MS
First Name:RAELEEN
Middle Name:
Last Name:ORME
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1139 PARK RIDGE DR
Mailing Address - Street 2:#512-2
Mailing Address - City:ROOSEVELT
Mailing Address - State:UT
Mailing Address - Zip Code:84066-3902
Mailing Address - Country:US
Mailing Address - Phone:435-452-8080
Mailing Address - Fax:
Practice Address - Street 1:210 W 300 N
Practice Address - Street 2:#75-3
Practice Address - City:ROOSEVELT
Practice Address - State:UT
Practice Address - Zip Code:84066-2336
Practice Address - Country:US
Practice Address - Phone:435-722-6130
Practice Address - Fax:435-725-2033
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-23
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT198259-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily