Healthcare Provider Details

I. General information

NPI: 1497220149
Provider Name (Legal Business Name): NANCY DUNCAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2018
Last Update Date: 10/21/2021
Certification Date: 10/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 S CHIPETA WAY
SALT LAKE CITY UT
84108-1260
US

IV. Provider business mailing address

14734 S RISING STAR WAY
BLUFFDALE UT
84065-5809
US

V. Phone/Fax

Practice location:
  • Phone: 480-544-7862
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number11609282-1206
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: