Provider Demographics
NPI:1245065721
Name:MCARDLE, ALEC TRAVIS
Entity type:Individual
Prefix:
First Name:ALEC
Middle Name:TRAVIS
Last Name:MCARDLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10402 S SAGE CANAL WAY
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-1348
Mailing Address - Country:US
Mailing Address - Phone:801-386-4450
Mailing Address - Fax:
Practice Address - Street 1:10402 S SAGE CANAL WAY
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-1348
Practice Address - Country:US
Practice Address - Phone:801-386-4450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11581576-3102163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine