Healthcare Provider Details

I. General information

NPI: 1962278556
Provider Name (Legal Business Name): NICHOLAS CLOWARD NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2023
Last Update Date: 04/01/2024
Certification Date: 04/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 W 950 N
CENTERVILLE UT
84014-1364
US

IV. Provider business mailing address

441 S 100 W
AMERICAN FORK UT
84003-2603
US

V. Phone/Fax

Practice location:
  • Phone: 801-447-1615
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6185751-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number6185751-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: