Healthcare Provider Details

I. General information

NPI: 1508292780
Provider Name (Legal Business Name): CHRISTIAN DEGREY FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2013
Last Update Date: 12/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 RIVER PARK DR 200
PROVO UT
84604-5764
US

IV. Provider business mailing address

280 RIVER PARK DR 200
PROVO UT
84604-5764
US

V. Phone/Fax

Practice location:
  • Phone: 801-223-4860
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7216842-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: