Healthcare Provider Details

I. General information

NPI: 1487080438
Provider Name (Legal Business Name): SHERYL LEE DESPIEGELAERE NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2013
Last Update Date: 02/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3903 HARRISON BLVD STE 100
OGDEN UT
84403-2361
US

IV. Provider business mailing address

5444 S GREEN ST
MURRAY UT
84123-5632
US

V. Phone/Fax

Practice location:
  • Phone: 801-387-8900
  • Fax: 801-387-8920
Mailing address:
  • Phone: 801-313-4140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number8546547-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number8546547-4405
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: