Healthcare Provider Details

I. General information

NPI: 1619748464
Provider Name (Legal Business Name): RACHEL GATHRO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2024
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

763 N REDWOOD RD STE 110
NORTH SALT LAKE UT
84054-2895
US

IV. Provider business mailing address

5233 W ARMADA WAY
HERRIMAN UT
84096-8308
US

V. Phone/Fax

Practice location:
  • Phone: 801-292-1423
  • Fax:
Mailing address:
  • Phone: 801-885-0889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number10837186-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number10837186-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: