Healthcare Provider Details

I. General information

NPI: 1073237624
Provider Name (Legal Business Name): SIERRA ROSE MAYZSAK APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2022
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 E 6000 S
OGDEN UT
84405-7144
US

IV. Provider business mailing address

PO BOX 5546
DENVER CO
80217-5546
US

V. Phone/Fax

Practice location:
  • Phone: 801-337-5800
  • Fax: 801-337-5809
Mailing address:
  • Phone: 801-475-3500
  • Fax: 801-475-3494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number10086344-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: