Healthcare Provider Details

I. General information

NPI: 1346256492
Provider Name (Legal Business Name): AUDREY M. STEVENSON APRN,BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5911 S. FASHION PLACE BLVD
MURRAY UT
84107
US

IV. Provider business mailing address

2602 RUSTIC MEADOW CIR
SOUTH JORDAN UT
84095-8608
US

V. Phone/Fax

Practice location:
  • Phone: 801-266-6483
  • Fax:
Mailing address:
  • Phone: 801-254-2540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number204655-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: