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NPI Code Detail

MEDICARE: MS. STEPHANIE YURI NAGATA FNP

MEDICARE: MS. STEPHANIE YURI NAGATA FNP
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 Practitioner216823-4405UT

General Provider Information

NPI Number : 1558540310
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. STEPHANIE YURI NAGATA FNP
Provider Business Mailing Address
First Line : 2176 S 2300 E
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84109-1202
Country : US
Telephone Number : 801-486-9362
Fax Number :
Provider Business Practice Location Address
First Line : 654 S 900 E
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84102-3478
Country : US
Telephone Number : 801-532-1586
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/29/2007
Last Update Date : 10/29/2007

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