Healthcare Provider Details

I. General information

NPI: 1013210236
Provider Name (Legal Business Name): CONNIE DENISE TAYLOR NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2010
Last Update Date: 11/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 S 200 E STE 100
PROVO UT
84606-3146
US

IV. Provider business mailing address

2561 S 1560 W STE B
WOODS CROSS UT
84087-2361
US

V. Phone/Fax

Practice location:
  • Phone: 801-877-5801
  • Fax: 801-877-5802
Mailing address:
  • Phone: 801-505-0821
  • Fax: 801-505-0803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6089333-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: