Healthcare Provider Details

I. General information

NPI: 1124676044
Provider Name (Legal Business Name): MARIE R. TIMOTHY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2019
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 E 3100 N
LAYTON UT
84040-2406
US

IV. Provider business mailing address

2121 N 1700 W
LAYTON UT
84041-8803
US

V. Phone/Fax

Practice location:
  • Phone: 801-773-4840
  • Fax: 801-525-3164
Mailing address:
  • Phone: 801-773-4840
  • Fax: 801-525-3164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number327899-4405
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number327899-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: