Healthcare Provider Details

I. General information

NPI: 1881401768
Provider Name (Legal Business Name): MARCOS ANTONIO LIMEIRA SEGUNDO APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2024
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 N 400 W
OREM UT
84057-1909
US

IV. Provider business mailing address

153 N 400 W
OREM UT
84057-1909
US

V. Phone/Fax

Practice location:
  • Phone: 801-921-2260
  • Fax: 855-566-8337
Mailing address:
  • Phone: 715-240-0054
  • Fax: 855-566-8337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number12852832-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: