Healthcare Provider Details

I. General information

NPI: 1194530469
Provider Name (Legal Business Name): CINDY JO HISH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2025
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

449 E 2100 S
SALT LAKE CITY UT
84115-2237
US

IV. Provider business mailing address

4527 S 1175 W APT 93
TAYLORSVILLE UT
84123-2903
US

V. Phone/Fax

Practice location:
  • Phone: 801-440-1380
  • Fax:
Mailing address:
  • Phone: 801-440-1380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number174155-3101
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number174155-3101
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: