Healthcare Provider Details

I. General information

NPI: 1760160519
Provider Name (Legal Business Name): MAURA HARTZMAN DACM, DIP. OM, L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2023
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 S 1100 E STE 3
SALT LAKE CITY UT
84105-3492
US

IV. Provider business mailing address

1760 S 1100 E
SALT LAKE CITY UT
84105-3400
US

V. Phone/Fax

Practice location:
  • Phone: 435-315-2616
  • Fax:
Mailing address:
  • Phone: 336-509-8945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberNC-2084
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number13412435-1201
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: