Healthcare Provider Details

I. General information

NPI: 1487615852
Provider Name (Legal Business Name): DAVID J KOTTER APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 08/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5171 COTTONWOOD ST STE 950
MURRAY UT
84107-5704
US

IV. Provider business mailing address

5171 COTTONWOOD ST STE 950
MURRAY UT
84107-5704
US

V. Phone/Fax

Practice location:
  • Phone: 801-507-9555
  • Fax: 801-507-9550
Mailing address:
  • Phone: 801-507-9555
  • Fax: 801-507-9550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4813708-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: