Healthcare Provider Details

I. General information

NPI: 1215520333
Provider Name (Legal Business Name): SAMANTA ANORVE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2021
Last Update Date: 09/30/2022
Certification Date: 09/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1370 S WEST TEMPLE
SALT LAKE CITY UT
84115-5218
US

IV. Provider business mailing address

1370 S WEST TEMPLE
SALT LAKE CITY UT
84115-5218
US

V. Phone/Fax

Practice location:
  • Phone: 801-678-3317
  • Fax:
Mailing address:
  • Phone: 801-678-3317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: