Sunrise Womens Health and Wellness PLLC
Organization Active NPI Multi-Specialty Clinic/Center · Mapleton, UT
NPI 1720748874 · NPPES record last updated Oct 24, 2022
Key facts
- NPI
- 1720748874
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Multi-Specialty Clinic/Center 261QM1300X
- Legal business name
- SUNRISE WOMENS HEALTH AND WELLNESS PLLC
- Practice address
- 724 S 1600 W Ste 200
Mapleton, UT 84664-4349 - Phone
- (385) 448-0055
- Fax
- (801) 797-0281
- NPI assigned
- Dec 29, 2021
- Organization subpart
- No
Authorized official
- Name
- Derrick Pickering, FNP
- Title
- Owner
- Phone
- (385) 448-0055
Practitioners 3
-
Derrick Evan Pickering, N.P.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20221230000320 | UT | Part B Supplier - Clinic/Group Practice | 1658741095 |
Receives reassigned benefits from 1 practitioner Practice locations: Mapleton, UT |
National Provider Directory
Locations
724 S 1600 W
Ste 200
Mapleton, UT 84664
Phone (385) 448-0055
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Multi-Specialty Clinic/Center | 261QM1300X | Yes |
Addresses
Primary practice location
724 S 1600 W Ste 200
Mapleton, UT 84664-4349
Mailing address
724 S 1600 W Ste 200
Mapleton, UT 84664-4349
Phone (385) 448-0055
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720497597 | Other | NPPES |
Other providers in Mapleton, UT
- Gillan Maclean Smith
- Stellify Trauma Therapy
- Stonehaven Dental - Mapleton LLC
- Stonehenge Care LLC
- Sundance Dermatology, LLC
- Keegan Taylor
- Telerad of Ut Account Management LLC
- Brett W Thompson
- Whitney Hill Thompson
- Dallin Hathaway Thueson
All providers in Mapleton, UT · Multi-Specialty Clinic/Center in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 24, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.