Provider Demographics
NPI:1043385446
Name:RAFF, MARLA (RN)
Entity type:Individual
Prefix:
First Name:MARLA
Middle Name:
Last Name:RAFF
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1164 S 730 W
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:UT
Mailing Address - Zip Code:84651-3108
Mailing Address - Country:US
Mailing Address - Phone:801-465-9655
Mailing Address - Fax:
Practice Address - Street 1:151 S UNIVERSITY AVE # 1900
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84601-4427
Practice Address - Country:US
Practice Address - Phone:801-851-7059
Practice Address - Fax:801-343-8759
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT188377-3102163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT55102OtherPEHP PROVIDER#
UT998877660009Medicaid
UTPR00489Medicaid
UT103003506102OtherSELECT HEALTH PROVIDER#
UTQM0000039389OtherALTIUS PROVIDER#
UT73-00012OtherUNITED HEALTHCARE ID#