Healthcare Provider Details

I. General information

NPI: 1902535107
Provider Name (Legal Business Name): STEFANIE SIMONS CAMASSI AGNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STEFANIE SIMONS AGNP

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1878 W 12600 S STE 336
RIVERTON UT
84065-7026
US

IV. Provider business mailing address

14286 S JACKSON FIELD WAY
HERRIMAN UT
84096-2803
US

V. Phone/Fax

Practice location:
  • Phone: 801-879-9104
  • Fax:
Mailing address:
  • Phone: 801-879-9104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number7960610-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number7960610-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: