MEDICARE: MR. GEOFFREY JAMES HECKEL FNP, DNP, APRN

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	4868524-4405	UT

General Provider Information

NPI Number	:	1528478419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GEOFFREY JAMES HECKEL FNP, DNP, APRN

Provider Business Mailing Address
First Line	:	2750 S 5600 W
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84120-1249
Country	:	US
Telephone Number	:	801-417-5734
Fax Number	:

Provider Business Practice Location Address
First Line	:	2750 S 5600 W
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84120-1249
Country	:	US
Telephone Number	:	801-417-5734
Fax Number	:

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

Provider Enumeration Date	:	05/01/2014
Last Update Date	:	05/01/2014

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