Healthcare Provider Details

I. General information

NPI: 1699670810
Provider Name (Legal Business Name): SERENA MARIE FUHRIMAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3775 S HIGHLAND DR STE 2
MILLCREEK UT
84106-4207
US

IV. Provider business mailing address

3775 S HIGHLAND DR STE 2
MILLCREEK UT
84106-4207
US

V. Phone/Fax

Practice location:
  • Phone: 801-233-8778
  • Fax:
Mailing address:
  • Phone: 801-233-8778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF08260889
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: