Healthcare Provider Details

I. General information

NPI: 1619546819
Provider Name (Legal Business Name): CLARE NICOLAS AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2021
Last Update Date: 06/22/2021
Certification Date: 06/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4063 W 12600 S
RIVERTON UT
84096-7302
US

IV. Provider business mailing address

4519 S ARCADIA GREEN WAY
MURRAY UT
84107-4190
US

V. Phone/Fax

Practice location:
  • Phone: 801-495-4800
  • Fax:
Mailing address:
  • Phone: 720-270-6033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number12324418-4101
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: