Healthcare Provider Details

I. General information

NPI: 1578473575
Provider Name (Legal Business Name): PAIJE PARKER
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

477 23RD ST
OGDEN UT
84401-1507
US

IV. Provider business mailing address

477 23RD ST
OGDEN UT
84401-1507
US

V. Phone/Fax

Practice location:
  • Phone: 801-399-7250
  • Fax: 801-399-7254
Mailing address:
  • Phone: 801-399-7250
  • Fax: 801-399-7254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number10355147-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: