Healthcare Provider Details

I. General information

NPI: 1104659671
Provider Name (Legal Business Name): NATALIE SATO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2024
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6095 S FASHION BLVD STE 150
MURRAY UT
84107-7386
US

IV. Provider business mailing address

142 BONA VISTA CIR
BOUNTIFUL UT
84010-6654
US

V. Phone/Fax

Practice location:
  • Phone: 801-747-2273
  • Fax:
Mailing address:
  • Phone: 925-683-1056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number10885549-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: