MEDICARE: MS. DENISE EVANS WARD F.N.P.

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	363LF0000X	Family Nurse Practitioner	178569-8900	UT

General Provider Information

NPI Number	:	1316192321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DENISE EVANS WARD F.N.P.

Provider Business Mailing Address
First Line	:	PO BOX 27128
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84127-0128
Country	:	US
Telephone Number	:	801-209-3601
Fax Number	:

Provider Business Practice Location Address
First Line	:	324 E 10TH AVE STE 170
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84103-2858
Country	:	US
Telephone Number	:	801-322-1000
Fax Number	:	801-442-0643

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

Provider Enumeration Date	:	11/19/2008
Last Update Date	:	07/21/2015

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