Healthcare Provider Details

I. General information

NPI: 1023995032
Provider Name (Legal Business Name): WHITNEY GOUDJIL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2025
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5121 S COTTONWOOD ST
MURRAY UT
84107-5701
US

IV. Provider business mailing address

6608 N TINTIC MTN
EAGLE MOUNTAIN UT
84005-5699
US

V. Phone/Fax

Practice location:
  • Phone: 801-507-6000
  • Fax:
Mailing address:
  • Phone: 801-718-7450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11580038-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: