Healthcare Provider Details

I. General information

NPI: 1720264369
Provider Name (Legal Business Name): MARIE WOODFIELD APRNI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2008
Last Update Date: 01/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5030 HARRISON BLVD
OGDEN UT
84403-4311
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-387-5600
  • Fax:
Mailing address:
  • Phone: 801-442-1400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number6763362-4408
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: