Provider Demographics
NPI:1780402073
Name:MAYER, MAKELSEA KAY (RN)
Entity type:Individual
Prefix:
First Name:MAKELSEA
Middle Name:KAY
Last Name:MAYER
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 1:13521 S PARK PRESIDIO WAY UNIT 1403
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-1989
Mailing Address - Country:US
Mailing Address - Phone:435-592-9886
Mailing Address - Fax:801-571-1338
Practice Address - Street 1:4775 W DAYBREAK PKWY STE 102
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84009-5139
Practice Address - Country:US
Practice Address - Phone:435-592-9886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14160359-3102163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse