Healthcare Provider Details

I. General information

NPI: 1447070156
Provider Name (Legal Business Name): DANE WOODWARD FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2024
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1868 N 1200 W
LAYTON UT
84041-1939
US

IV. Provider business mailing address

10433 S REDWOOD RD # 2
SOUTH JORDAN UT
84095-8502
US

V. Phone/Fax

Practice location:
  • Phone: 801-614-2772
  • Fax:
Mailing address:
  • Phone: 801-260-1919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10846405-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: