Healthcare Provider Details

I. General information

NPI: 1376797761
Provider Name (Legal Business Name): CAROL JEAN STOWELL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2008
Last Update Date: 02/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

677 W 5300 S
MURRAY UT
84123-5671
US

IV. Provider business mailing address

677 W 5300 S
MURRAY UT
84123-5671
US

V. Phone/Fax

Practice location:
  • Phone: 801-327-8700
  • Fax: 801-290-2847
Mailing address:
  • Phone: 801-327-8700
  • Fax: 801-290-2847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number216802-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: