Provider Demographics
NPI:1821498031
Name:UTAH MOBILE NP CONSULTING LLC
Entity Type:Organization
Organization Name:UTAH MOBILE NP CONSULTING LLC
Other - Org Name:STARFIRE COUNSULTING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:RUSIN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:801-898-1754
Mailing Address - Street 1:2907 W MIDWEST DR
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84129-2556
Mailing Address - Country:US
Mailing Address - Phone:801-898-1754
Mailing Address - Fax:
Practice Address - Street 1:2907 W MIDWEST DR
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84129-2556
Practice Address - Country:US
Practice Address - Phone:801-898-1754
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-26
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4757258-8900363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1235282872OtherPROFESSIONAL NPI