Healthcare Provider Details

I. General information

NPI: 1003282567
Provider Name (Legal Business Name): ENVISION PHYSICIAN SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2015
Last Update Date: 02/29/2020
Certification Date: 02/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1345 W 1600 N
OREM UT
84057-2431
US

IV. Provider business mailing address

125 E MAIN ST SUITE 121
AMERICAN FORK UT
84003-2407
US

V. Phone/Fax

Practice location:
  • Phone: 801-317-8099
  • Fax:
Mailing address:
  • Phone: 801-225-7971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. SHERIE STEWART
Title or Position: MANAGER
Credential: STEWART
Phone: 801-225-7971