Mortensen, Dominique

Mortensen, Dominique is an individual health care provider with primary practice located at 475 W 260 N , Orem UT 84057-1970. She recently has only one registered license in Technologists, Technicians & Other Technical Service Providers / Technician, Other, which is considered as her primary health care specialty. Mortensen, Dominique can be contacted via phone (801) 221-9930.

Contact Information

Primary practice address
475 W 260 N Orem UT 84057-1970
Phone: (801) 221-9930
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Technologists, Technicians & Other Technical Service Providers / Technician, Other 247200000X

Profile Details

NPI number 1386196715
LBN Legal business name Mortensen, Dominique
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 2nd, 2016
Last updated Nov 2nd, 2016 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1386196715 NPPES
Utah MEDICAID 1396085718

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