Healthcare Provider Details

I. General information

NPI: 1962359356
Provider Name (Legal Business Name): ALEXIS SQUIRE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2026
Last Update Date: 03/13/2026
Certification Date: 03/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 S 1100 E STE 102
SALT LAKE CITY UT
84102-1565
US

IV. Provider business mailing address

3363 BOUNTIFUL BLVD
BOUNTIFUL UT
84010-4465
US

V. Phone/Fax

Practice location:
  • Phone: 801-532-0204
  • Fax:
Mailing address:
  • Phone: 801-318-0952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11195391-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: