Basic Information
| Provider Information | |||||||||
| NPI: | 1356988604 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ORTON | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | SETH | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3183 E SUGAR MAPLE DR | ||||||||
| Address2: | |||||||||
| City: | ST GEORGE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 847901394 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8018591796 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1380 E MEDICAL CENTER DR | ||||||||
| Address2: | |||||||||
| City: | ST GEORGE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 847902123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4352512992 | ||||||||
| FaxNumber: | 4352511625 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2019 | ||||||||
| LastUpdateDate: | 04/17/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 7643463-3102 | UT | N | Nursing Service Providers | Registered Nurse | 363LF0000X | 7643463-4405 | UT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.