Provider Demographics
NPI:1942057500
Name:FARNSWORTH, REBECCA ANN (APRN)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:FARNSWORTH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11893 S AZTEC RD
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-6804
Mailing Address - Country:US
Mailing Address - Phone:801-201-8266
Mailing Address - Fax:
Practice Address - Street 1:11893 S AZTEC RD
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-6804
Practice Address - Country:US
Practice Address - Phone:801-201-8266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-02
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4863132-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily