Healthcare Provider Details

I. General information

NPI: 1881507523
Provider Name (Legal Business Name): LANDON GORDON
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 W 5400 S
MURRAY UT
84107-5893
US

IV. Provider business mailing address

302 W 5400 S
MURRAY UT
84107-5893
US

V. Phone/Fax

Practice location:
  • Phone: 801-456-2333
  • Fax:
Mailing address:
  • Phone: 801-456-2333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number12296567-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: