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NPI Code Detail

MEDICARE: WASATCH NURSE PRACTITIONER SERVICES

MEDICARE: WASATCH NURSE PRACTITIONER SERVICES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner1166904405UT

General Provider Information

NPI Number : 1063798403
Entity Type Code : Organization
Provider Name (Legal Business Name) : WASATCH NURSE PRACTITIONER SERVICES
Provider Business Mailing Address
First Line : 3683 WILDROSE LN
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84109-4324
Country : US
Telephone Number : 801-918-9793
Fax Number :
Provider Business Practice Location Address
First Line : 3683 WILDROSE LN
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84109-4324
Country : US
Telephone Number : 801-918-9793
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. SANDRA W BAGLEY
Credential : FNP
Telephone Number : 801-918-9793
Provider Enumeration Date : 10/31/2011
Last Update Date : 10/31/2011

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Directions to “WASATCH NURSE PRACTITIONER SERVICES ” Practice Location

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