Healthcare Provider Details

I. General information

NPI: 1700077229
Provider Name (Legal Business Name): HITOMI NASHIYAMA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2007
Last Update Date: 04/04/2022
Certification Date: 04/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4421 HARRISON BLVD STE A12
OGDEN UT
84403-3174
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-387-3065
  • Fax:
Mailing address:
  • Phone: 801-233-4400
  • Fax: 801-233-4410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5796226-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number5796226-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: