Healthcare Provider Details

I. General information

NPI: 1609717834
Provider Name (Legal Business Name): CHALYSE S RODRIGUES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

641 W 1290 N
LEHI UT
84043-2327
US

IV. Provider business mailing address

641 W 1290 N
LEHI UT
84043-2327
US

V. Phone/Fax

Practice location:
  • Phone: 801-796-2678
  • Fax: 801-877-5583
Mailing address:
  • Phone: 801-796-2678
  • Fax: 801-877-5583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number13139563-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: