Healthcare Provider Details

I. General information

NPI: 1053234997
Provider Name (Legal Business Name): IVIE WITTWER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 W 800 N
OREM UT
84057-3660
US

IV. Provider business mailing address

1594 E BLACKHAWK DR
PLEASANT GROVE UT
84062-3320
US

V. Phone/Fax

Practice location:
  • Phone: 801-714-6000
  • Fax:
Mailing address:
  • Phone: 435-619-9942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number12050190-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: