Healthcare Provider Details

I. General information

NPI: 1093638249
Provider Name (Legal Business Name): SANAVERA MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6626B W WIDE HOLLOW DR
HERRIMAN UT
84096-3550
US

IV. Provider business mailing address

6626 W WIDE HOLLOW DR
HERRIMAN UT
84096-3550
US

V. Phone/Fax

Practice location:
  • Phone: 661-992-3146
  • Fax:
Mailing address:
  • Phone: 661-992-3146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KATHLEEN MITCHELL
Title or Position: OWNER
Credential: FNP
Phone: 661-992-3146