Basic Information
Provider Information | |||||||||
NPI: | 1285866491 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | PRESCOTT | ||||||||
FirstName: | JANELLE | ||||||||
MiddleName: | B | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | CRNA | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | BASTIAN | ||||||||
OtherFirstName: | JANELLE | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: | MS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | R.N. | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 3750 | ||||||||
Address2: |   | ||||||||
City: | SALT LAKE CITY | ||||||||
State: | UT | ||||||||
PostalCode: | 841103750 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8007484868 | ||||||||
FaxNumber: | 7707016676 | ||||||||
Practice Location | |||||||||
Address1: | 3000 N TRIUMPH BLVD | ||||||||
Address2: |   | ||||||||
City: | LEHI | ||||||||
State: | UT | ||||||||
PostalCode: | 840434999 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3853453000 | ||||||||
FaxNumber: | 7707016676 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/20/2009 | ||||||||
LastUpdateDate: | 03/17/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN66063 | HI | N |   | Nursing Service Providers | Registered Nurse |   | 367500000X | 5284404-4406 | UT | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |   |
No ID Information.