Healthcare Provider Details

I. General information

NPI: 1407656093
Provider Name (Legal Business Name): MARCIA DE OLIVEIRA SILVA ALVES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2025
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 385-208-2676
  • Fax:
Mailing address:
  • Phone: 385-208-2676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number12032331-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number12032331-4405
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number12032331-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: