Healthcare Provider Details

I. General information

NPI: 1902746720
Provider Name (Legal Business Name): TAMARA BERNSTEIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

934 S MAIN ST
LAYTON UT
84041-7135
US

IV. Provider business mailing address

934 S MAIN ST
LAYTON UT
84041-7135
US

V. Phone/Fax

Practice location:
  • Phone: 801-336-1845
  • Fax:
Mailing address:
  • Phone: 801-336-1845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number11761906-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: