MEDICARE: JOSH TWITCHELL

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
1	163WN0800X	Neuroscience Registered Nurse	8757899-3102	UT
2	363LF0000X	Family Nurse Practitioner	11909799-4405	UT

General Provider Information

NPI Number	:	1265093777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSH TWITCHELL

Provider Business Mailing Address
First Line	:	1408 E GILMER DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-1605
Country	:	US
Telephone Number	:	801-673-0488
Fax Number	:

Provider Business Practice Location Address
First Line	:	1408 E GILMER DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-1605
Country	:	US
Telephone Number	:	801-673-0488
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2019
Last Update Date	:	05/03/2022

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Directions to “ JOSH TWITCHELL ” Practice Location

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