Healthcare Provider Details

I. General information

NPI: 1205893716
Provider Name (Legal Business Name): MICHELLE WILKINSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 05/23/2026
Certification Date: 05/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3115 E LION LN STE 220
HOLLADAY UT
84121-3529
US

IV. Provider business mailing address

3810 S ASHLAND DR
MILLCREEK UT
84109-3503
US

V. Phone/Fax

Practice location:
  • Phone: 385-333-6000
  • Fax: 385-341-8345
Mailing address:
  • Phone: 801-599-0174
  • Fax: 385-341-8345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number367136-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: