Healthcare Provider Details

I. General information

NPI: 1508162736
Provider Name (Legal Business Name): OLYMPUS MEDICAL HOUSE CALLS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2011
Last Update Date: 02/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3096 MARIE CIR
SALT LAKE CITY UT
84109-2446
US

IV. Provider business mailing address

3096 MARIE CIR
SALT LAKE CITY UT
84109-2446
US

V. Phone/Fax

Practice location:
  • Phone: 801-809-2119
  • Fax:
Mailing address:
  • Phone: 801-809-2119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4779643-4405
License Number StateUT

VIII. Authorized Official

Name: LAURA CHAMBERLAIN
Title or Position: NURSE PRACTITIONER
Credential: MSN, NP-C
Phone: 801-809-2119