Healthcare Provider Details

I. General information

NPI: 1871407817
Provider Name (Legal Business Name): CARLA V BUTTNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3945 WASHINGTON BLVD
OGDEN UT
84403-1988
US

IV. Provider business mailing address

3945 WASHINGTON BLVD
OGDEN UT
84403-1988
US

V. Phone/Fax

Practice location:
  • Phone: 801-582-1565
  • Fax:
Mailing address:
  • Phone: 801-479-4105
  • Fax: 801-584-2590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number376045-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: