Provider Demographics
NPI:1760031603
Name:WALBRECHT, ELIZABETH LAYNE (RN)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LAYNE
Last Name:WALBRECHT
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 1:130 W SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720-3547
Mailing Address - Country:US
Mailing Address - Phone:801-949-4211
Mailing Address - Fax:
Practice Address - Street 1:260 DL SARGENT DR
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84721-9342
Practice Address - Country:US
Practice Address - Phone:435-586-2437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT108501483102163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse