Healthcare Provider Details

I. General information

NPI: 1699684290
Provider Name (Legal Business Name): SANDRA B FORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SANDRA L FORD RN

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 E 6850 S
MIDVALE UT
84047-1215
US

IV. Provider business mailing address

1918 E BRANDON PARK TER
SANDY UT
84092-5235
US

V. Phone/Fax

Practice location:
  • Phone: 801-568-6700
  • Fax:
Mailing address:
  • Phone: 801-694-6513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number215888-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: