Healthcare Provider Details

I. General information

NPI: 1437991916
Provider Name (Legal Business Name): EDITH MARIE HOTH MSN, PMHNP-BC, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARIE ALEXANDER-HOTH MSN, PMHNP-BC, APRN

II. Dates (important events)

Enumeration Date: 06/06/2024
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 S HWY 40
HEBER CITY UT
84032
US

IV. Provider business mailing address

3682 W IRIS GLEN CT
SOUTH JORDAN UT
84009-3432
US

V. Phone/Fax

Practice location:
  • Phone: 801-885-5859
  • Fax:
Mailing address:
  • Phone: 801-885-5859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5972527-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: