Healthcare Provider Details

I. General information

NPI: 1245696913
Provider Name (Legal Business Name): TAYLOR SWENSON III F.N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2016
Last Update Date: 05/22/2020
Certification Date: 05/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 W 2700 N
PLEASANT VIEW UT
84404-4791
US

IV. Provider business mailing address

PO BOX 555
DENVER CO
80201-0555
US

V. Phone/Fax

Practice location:
  • Phone: 801-475-3600
  • Fax: 801-475-3601
Mailing address:
  • Phone: 801-475-3500
  • Fax: 801-475-3489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number8171394-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: