Healthcare Provider Details

I. General information

NPI: 1487185088
Provider Name (Legal Business Name): MICHAEL WOOLMAN MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2017
Last Update Date: 03/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2406 WOODLAND DR
OGDEN UT
84403-5110
US

IV. Provider business mailing address

PO BOX 908
BOUNTIFUL UT
84011-0908
US

V. Phone/Fax

Practice location:
  • Phone: 801-791-6543
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number163657-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number163657-1205
License Number StateUT

VIII. Authorized Official

Name: MICHAEL WOOLMAN
Title or Position: OWNER/PROVIDER
Credential: M.D.
Phone: 801-791-6543