MEDICARE: JOSEPH BORSHANIAN NP

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	363L00000X	Nurse Practitioner	222793-4405	UT

General Provider Information

NPI Number	:	1417917501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH BORSHANIAN NP

Provider Business Mailing Address
First Line	:	144 S 500 E
Second Line	:	2ND FLOOR
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-1907
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3460 PIONEER PKWY
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84120-2049
Country	:	US
Telephone Number	:	801-964-3100
Fax Number	:

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

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	04/21/2010

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