Basic Information
| Provider Information | |||||||||
| NPI: | 1427463561 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EINELUND | ||||||||
| FirstName: | OLE | ||||||||
| MiddleName: | MARTIN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 867 | ||||||||
| Address2: | |||||||||
| City: | PRICE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 845010867 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4356377200 | ||||||||
| FaxNumber: | 4356372377 | ||||||||
| Practice Location | |||||||||
| Address1: | 198 EAST CENTER STREET | ||||||||
| Address2: | |||||||||
| City: | MOAB | ||||||||
| State: | UT | ||||||||
| PostalCode: | 845320000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4352596131 | ||||||||
| FaxNumber: | 4352595369 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2014 | ||||||||
| LastUpdateDate: | 06/27/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0808X | 7805035-3102 | UT | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health |
No ID Information.