Healthcare Provider Details

I. General information

NPI: 1790458933
Provider Name (Legal Business Name): MIRIEL HOPE COLLINS PITTMAN FNP-BC, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2021
Last Update Date: 09/27/2021
Certification Date: 09/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

434 W ASCENSION WAY STE 225
MURRAY UT
84123-2985
US

IV. Provider business mailing address

434 W ASCENSION WAY STE 225
MURRAY UT
84123-2985
US

V. Phone/Fax

Practice location:
  • Phone: 801-716-7008
  • Fax: 888-990-1557
Mailing address:
  • Phone: 801-716-7008
  • Fax: 888-990-1557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9314012-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: