Healthcare Provider Details

I. General information

NPI: 1174435788
Provider Name (Legal Business Name): VANCE GARRETT COLTRANE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

14780 S RISING STAR WAY
BLUFFDALE UT
84065-5809
US

IV. Provider business mailing address

14780 S RISING STAR WAY
BLUFFDALE UT
84065-5809
US

V. Phone/Fax

Practice location:
  • Phone: 801-928-4380
  • Fax:
Mailing address:
  • Phone: 801-928-4380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: