Healthcare Provider Details

I. General information

NPI: 1043972821
Provider Name (Legal Business Name): SHARMAN SUMMERS CLAYTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2021
Last Update Date: 03/23/2022
Certification Date: 03/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1659 LAKEVIEW DR
BOUNTIFUL UT
84010-1561
US

IV. Provider business mailing address

1659 LAKEVIEW DR
BOUNTIFUL UT
84010-1561
US

V. Phone/Fax

Practice location:
  • Phone: 801-793-3357
  • Fax:
Mailing address:
  • Phone: 801-793-3357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number318482-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number318482-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: