Healthcare Provider Details

I. General information

NPI: 1265963300
Provider Name (Legal Business Name): DAMON BELL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2017
Last Update Date: 06/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 N CANYON RD
PROVO UT
84604-4571
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-373-3300
  • Fax:
Mailing address:
  • Phone: 801-373-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number7757911-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: