Healthcare Provider Details

I. General information

NPI: 1003680117
Provider Name (Legal Business Name): ASHLEY SAUNDERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2023
Last Update Date: 11/16/2023
Certification Date: 11/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 N 500 W BLDG A
PROVO UT
84604-3305
US

IV. Provider business mailing address

1055 N 500 W ATTN CREDENTIALING
PROVO UT
84604-3305
US

V. Phone/Fax

Practice location:
  • Phone: 801-812-5033
  • Fax: 801-812-5034
Mailing address:
  • Phone: 801-812-5033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9524932-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: