Healthcare Provider Details

I. General information

NPI: 1568239077
Provider Name (Legal Business Name): HYRUM SNELL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2023
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5217 S STATE ST
MURRAY UT
84107-4813
US

IV. Provider business mailing address

455 S KAYS DR
KAYSVILLE UT
84037-4208
US

V. Phone/Fax

Practice location:
  • Phone: 801-313-4110
  • Fax:
Mailing address:
  • Phone: 801-200-9612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: