Provider Demographics
NPI:1134749419
Name:VOM DORP, REBECCA DELLANIRA
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:DELLANIRA
Last Name:VOM DORP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 E 800 S
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-2450
Mailing Address - Country:US
Mailing Address - Phone:801-489-3344
Mailing Address - Fax:
Practice Address - Street 1:321 E 800 S
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:UT
Practice Address - Zip Code:84663-2450
Practice Address - Country:US
Practice Address - Phone:801-489-3344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-16
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2019-ALII-UT000839376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator