Healthcare Provider Details

I. General information

NPI: 1629966874
Provider Name (Legal Business Name): SAVANNAH BROOKE COTTAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2025
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1756 W PARK AVE
RIVERTON UT
84065-4701
US

IV. Provider business mailing address

1756 W PARK AVE
RIVERTON UT
84065-4701
US

V. Phone/Fax

Practice location:
  • Phone: 801-254-1012
  • Fax:
Mailing address:
  • Phone: 801-655-5899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9817924-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: