Healthcare Provider Details

I. General information

NPI: 1356913693
Provider Name (Legal Business Name): HANNAH BJORKMAN STAUBER NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2021
Last Update Date: 12/28/2021
Certification Date: 12/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12433 S FORT ST
DRAPER UT
84020-9363
US

IV. Provider business mailing address

12433 S FORT ST
DRAPER UT
84020-9363
US

V. Phone/Fax

Practice location:
  • Phone: 801-576-1086
  • Fax:
Mailing address:
  • Phone: 801-576-1086
  • Fax: 801-576-9796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number92683274405
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number8268327-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: