Healthcare Provider Details

I. General information

NPI: 1558059683
Provider Name (Legal Business Name): SAMANTHA BOLTON DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2023
Last Update Date: 01/21/2026
Certification Date: 01/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 W 400 N
OREM UT
84057-1916
US

IV. Provider business mailing address

527 W 400 N
OREM UT
84057-1916
US

V. Phone/Fax

Practice location:
  • Phone: 801-714-3570
  • Fax:
Mailing address:
  • Phone: 801-714-3570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number8510211-4402
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number8510211-4402
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number8510211-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: