Provider Demographics
NPI:1790013423
Name:RASBAND, REVA J (FNP)
Entity Type:Individual
Prefix:MRS
First Name:REVA
Middle Name:J
Last Name:RASBAND
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 W 1600 N
Mailing Address - Street 2:STE 202
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-2431
Mailing Address - Country:US
Mailing Address - Phone:866-471-5733
Mailing Address - Fax:
Practice Address - Street 1:1345 W 1600 N
Practice Address - Street 2:STE 202
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-2431
Practice Address - Country:US
Practice Address - Phone:866-471-5733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-18
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT325855-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily