Healthcare Provider Details

I. General information

NPI: 1558394692
Provider Name (Legal Business Name): JOELLE M CREAGER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 11/12/2021
Certification Date: 11/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

698 12TH ST
OGDEN UT
84404-5877
US

IV. Provider business mailing address

1055 N 500 W
PROVO UT
84604-3305
US

V. Phone/Fax

Practice location:
  • Phone: 801-621-3466
  • Fax:
Mailing address:
  • Phone: 801-375-8858
  • Fax: 801-418-0941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2654394405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: