Healthcare Provider Details

I. General information

NPI: 1811352693
Provider Name (Legal Business Name): TONYA PATTERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2015
Last Update Date: 12/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 N UNIVERSITY AVE
PROVO UT
84604-5504
US

IV. Provider business mailing address

461 W 1885 N
OREM UT
84057-2032
US

V. Phone/Fax

Practice location:
  • Phone: 801-318-9779
  • Fax: 801-227-2014
Mailing address:
  • Phone: 801-318-9779
  • Fax: 801-227-2014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number6232799-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: