Healthcare Provider Details

I. General information

NPI: 1215716295
Provider Name (Legal Business Name): ADDISON CLOWARD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2023
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 E 770 N STE B
OREM UT
84097-4107
US

IV. Provider business mailing address

903 E 100 S
PAYSON UT
84651-1685
US

V. Phone/Fax

Practice location:
  • Phone: 801-221-0669
  • Fax: 801-221-0797
Mailing address:
  • Phone: 801-850-7293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number12054392-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: