Healthcare Provider Details

I. General information

NPI: 1366072845
Provider Name (Legal Business Name): NATHAN STEVENSON DNP, FNP-C, WHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2020
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7321 BALMER ST BLDG 570
HILL AFB UT
84056-5012
US

IV. Provider business mailing address

7321 BALMER ST BLDG 570
HILL AFB UT
84056-5012
US

V. Phone/Fax

Practice location:
  • Phone: 801-777-7710
  • Fax:
Mailing address:
  • Phone: 801-777-7710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number12929059-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number12929059-4405
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number12929059-4405
License Number StateUT
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number12929059-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: