Healthcare Provider Details

I. General information

NPI: 1689345399
Provider Name (Legal Business Name): MICHELLE ANNE OAKS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2021
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 S 1000 E STE 200
PAYSON UT
84651-5592
US

IV. Provider business mailing address

1972 N 350 W
OREM UT
84057-8510
US

V. Phone/Fax

Practice location:
  • Phone: 801-465-2800
  • Fax:
Mailing address:
  • Phone: 801-623-8471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number8356670-4405
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: