Healthcare Provider Details

I. General information

NPI: 1366849127
Provider Name (Legal Business Name): LESLIE C NAKAYA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2014
Last Update Date: 07/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5979 S FASHION BLVD
MURRAY UT
84107-7364
US

IV. Provider business mailing address

2160 CLAREMONT DR
BOUNTIFUL UT
84010-2321
US

V. Phone/Fax

Practice location:
  • Phone: 801-263-2370
  • Fax:
Mailing address:
  • Phone: 801-809-1051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number348267-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: