Healthcare Provider Details

I. General information

NPI: 1336140821
Provider Name (Legal Business Name): JIM W. VAN ZANT RN,CS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

895 N 900 E
AMERICAN FORK UT
84003-9183
US

IV. Provider business mailing address

895 N 900 E
AMERICAN FORK UT
84003-9183
US

V. Phone/Fax

Practice location:
  • Phone: 801-763-4173
  • Fax: 801-763-4073
Mailing address:
  • Phone: 801-763-4173
  • Fax: 801-763-4073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number852132134405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: