Provider Demographics
NPI:1841825213
Name:C AND B FAMILY PRACTICE LLC
Entity type:Organization
Organization Name:C AND B FAMILY PRACTICE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:MRS
Authorized Official - First Name:CINDIE
Authorized Official - Middle Name:GAYLE
Authorized Official - Last Name:DODENBIER
Authorized Official - Suffix:
Authorized Official - Credentials:CFNP
Authorized Official - Phone:801-452-1066
Mailing Address - Street 1:P.O. BOX 332
Mailing Address - Street 2:
Mailing Address - City:ALTAMONT
Mailing Address - State:UT
Mailing Address - Zip Code:84001
Mailing Address - Country:US
Mailing Address - Phone:801-725-6872
Mailing Address - Fax:435-454-3200
Practice Address - Street 1:4601 N 16750 W
Practice Address - Street 2:
Practice Address - City:ALTONAH
Practice Address - State:UT
Practice Address - Zip Code:84002
Practice Address - Country:US
Practice Address - Phone:801-725-6872
Practice Address - Fax:435-454-3200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-06
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty