Basic Information
| Provider Information | |||||||||
| NPI: | 1760116883 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRATTON | ||||||||
| FirstName: | ALEXIS | ||||||||
| MiddleName: | ROSE | ||||||||
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| OtherLastName: | GRATTON | ||||||||
| OtherFirstName: | ALEX | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 574 W VINE ST | ||||||||
| Address2: | |||||||||
| City: | MURRAY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841234644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8018597740 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8031 S 700 E | ||||||||
| Address2: | |||||||||
| City: | SANDY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840700555 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3856952203 | ||||||||
| FaxNumber: | 4352927068 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2022 | ||||||||
| LastUpdateDate: | 07/13/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | Y |
No ID Information.