MEDICARE: WASATCH NP HOUSE CALLS LLC

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	363LA2200X	Adult Health Nurse Practitioner

General Provider Information

NPI Number	:	1982412375
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WASATCH NP HOUSE CALLS LLC

Provider Business Mailing Address
First Line	:	50 W BROADWAY STE 333
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84101-2027
Country	:	US
Telephone Number	:	801-252-5209
Fax Number	:

Provider Business Practice Location Address
First Line	:	3907 SILVER SPUR CIR
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84098-4819
Country	:	US
Telephone Number	:	801-252-5209
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KAITLYN PELLETIER
Credential	:
Telephone Number	:	801-252-5209

Provider Enumeration Date	:	12/18/2024
Last Update Date	:	12/18/2024

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