Healthcare Provider Details

I. General information

NPI: 1164393641
Provider Name (Legal Business Name): MA FAMILY HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2025
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12176 S 1000 E STE 12
DRAPER UT
84020-3221
US

IV. Provider business mailing address

4214 N LAKE MOUNTAIN RD
EAGLE MTN UT
84005-4002
US

V. Phone/Fax

Practice location:
  • Phone: 801-251-6255
  • Fax:
Mailing address:
  • Phone: 801-251-6255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARCIA DE OLIVEIRA SILVA ALVES
Title or Position: OWNER
Credential: NP
Phone: 801-251-6255