Healthcare Provider Details

I. General information

NPI: 1689451478
Provider Name (Legal Business Name): TAYLOR WIDDISON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2023
Last Update Date: 12/08/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 E 1400 N STE S
LOGAN UT
84341-2407
US

IV. Provider business mailing address

327 W 200 S
SMITHFIELD UT
84335-2111
US

V. Phone/Fax

Practice location:
  • Phone: 435-716-1860
  • Fax:
Mailing address:
  • Phone: 801-644-2504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License Number10371161-3102
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10371161-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: