Healthcare Provider Details

I. General information

NPI: 1912519117
Provider Name (Legal Business Name): DANIEL LEWIS MOORE NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2020
Last Update Date: 03/28/2026
Certification Date: 03/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4877 N RAVENCREST LN
LEHI UT
84048-7723
US

IV. Provider business mailing address

4877 N RAVENCREST LN
LEHI UT
84048-7723
US

V. Phone/Fax

Practice location:
  • Phone: 801-348-7172
  • Fax: 833-972-4809
Mailing address:
  • Phone: 801-348-7172
  • Fax: 435-986-7092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number8620638-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: