Healthcare Provider Details

I. General information

NPI: 1932665239
Provider Name (Legal Business Name): STEPHANIE LYNN BLUNDELL NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2019
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 RENAISSANCE TOWNE DR STE 500
BOUNTIFUL UT
84010-7678
US

IV. Provider business mailing address

1551 RENAISSANCE TOWNE DR STE 500
BOUNTIFUL UT
84010-7678
US

V. Phone/Fax

Practice location:
  • Phone: 801-295-7200
  • Fax: 801-295-4930
Mailing address:
  • Phone: 801-295-7200
  • Fax: 801-295-4930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number7374095-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: