Healthcare Provider Details

I. General information

NPI: 1073139853
Provider Name (Legal Business Name): CHARITY BUSHATI DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2020
Last Update Date: 03/22/2022
Certification Date: 03/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5475 S 500 E
OGDEN UT
84405-6905
US

IV. Provider business mailing address

1008 WESTBURY CT
NORTH SALT LAKE UT
84054-6029
US

V. Phone/Fax

Practice location:
  • Phone: 801-479-2111
  • Fax:
Mailing address:
  • Phone: 801-699-1952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number9424423-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number9424423-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: