Healthcare Provider Details

I. General information

NPI: 1073067088
Provider Name (Legal Business Name): LAURA W. BICKEL F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2016
Last Update Date: 10/21/2021
Certification Date: 10/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5131 S COTTONWOOD ST STE L2
MURRAY UT
84107-5701
US

IV. Provider business mailing address

1121 E 3900 S STE C230
SALT LAKE CITY UT
84124-1214
US

V. Phone/Fax

Practice location:
  • Phone: 801-263-3416
  • Fax: 801-263-3428
Mailing address:
  • Phone: 801-262-9494
  • Fax: 866-415-6807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7637585-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: