Healthcare Provider Details

I. General information

NPI: 1780308833
Provider Name (Legal Business Name): WHITNEY CORINNE JOHN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2022
Last Update Date: 01/29/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6095 S FASHION BLVD STE 220
MURRAY UT
84107-7393
US

IV. Provider business mailing address

3518 S VIRGINIA WAY
SALT LAKE CITY UT
84109-4148
US

V. Phone/Fax

Practice location:
  • Phone: 801-758-8735
  • Fax: 801-769-3991
Mailing address:
  • Phone: 801-558-6796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7321710-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: