Healthcare Provider Details

I. General information

NPI: 1326953977
Provider Name (Legal Business Name): YU LI
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2326 WASHINGTON BLVD
OGDEN UT
84401-1412
US

IV. Provider business mailing address

539 W COMMERCE ST # 2753
DALLAS TX
75208-1953
US

V. Phone/Fax

Practice location:
  • Phone: 315-961-9011
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number14281824-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: