Healthcare Provider Details

I. General information

NPI: 1265372213
Provider Name (Legal Business Name): SYDNEY NUTTALL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 W 500 S # 3
BOUNTIFUL UT
84010-6488
US

IV. Provider business mailing address

155 W 500 S # 3
BOUNTIFUL UT
84010-6488
US

V. Phone/Fax

Practice location:
  • Phone: 801-310-1721
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10376616-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: