Provider Demographics
NPI:1770659930
Name:YORK, JANE L (RN)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:L
Last Name:YORK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:BETTY
Other - Middle Name:JANE
Other - Last Name:YORK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:185 E 400 N
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:UT
Mailing Address - Zip Code:84651-1844
Mailing Address - Country:US
Mailing Address - Phone:801-465-4110
Mailing Address - Fax:801-465-4110
Practice Address - Street 1:151 S UNIVERSITY AVE # 1900
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84601-4427
Practice Address - Country:US
Practice Address - Phone:801-851-7049
Practice Address - Fax:801-343-8724
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT218049-3102163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT103003506102OtherSELECT HEALTH PROVIDER#
UTQM0000039389OtherALTIUS PROVIDER #
UTPR00489Medicaid
UT998877660009Medicaid
UT73-00012OtherUNITED HEALTHCARE #
UT55102OtherPEHP PROVIDER#