Provider Demographics
NPI:1053968370
Name:VANDERPLAS, MICHAEL JAMES SR (RN)
Entity type:Individual
Prefix:MRS
First Name:MICHAEL
Middle Name:JAMES
Last Name:VANDERPLAS
Suffix:SR
Gender:M
Credentials:RN
Other - Prefix:MRS
Other - First Name:MICHAEL
Other - Middle Name:JAMES
Other - Last Name:VANDERPLAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:3679 S 1900 E
Mailing Address - Street 2:
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84106-3846
Mailing Address - Country:US
Mailing Address - Phone:801-809-6290
Mailing Address - Fax:
Practice Address - Street 1:166 E 5900 S STE B102
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-7367
Practice Address - Country:US
Practice Address - Phone:801-809-6290
Practice Address - Fax:801-871-0581
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT60895343102163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse