Healthcare Provider Details

I. General information

NPI: 1649613589
Provider Name (Legal Business Name): DIETRA HILL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2013
Last Update Date: 04/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2440 N HWY 89 # C
HARRISVILLE UT
84404-2655
US

IV. Provider business mailing address

2440 N HWY 89 # C
HARRISVILLE UT
84404-2655
US

V. Phone/Fax

Practice location:
  • Phone: 801-393-6232
  • Fax: 801-393-4081
Mailing address:
  • Phone: 801-393-6232
  • Fax: 801-393-4081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: