Healthcare Provider Details

I. General information

NPI: 1982539052
Provider Name (Legal Business Name): TRAVERSE MOUNTAIN JOINT PAIN AND SPINE SPECIALIST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3051 W MAPLE LOOP DR STE 125
LEHI UT
84048-5620
US

IV. Provider business mailing address

1463 N 950 W
LEHI UT
84043-1099
US

V. Phone/Fax

Practice location:
  • Phone: 801-830-0017
  • Fax:
Mailing address:
  • Phone: 801-830-0017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MARISSA DUFUR
Title or Position: OWNER/PROVIDER
Credential: APRN
Phone: 801-830-0017