Healthcare Provider Details

I. General information

NPI: 1154176618
Provider Name (Legal Business Name): SARAH JOE CAMPBELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2024
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 N MEDICAL DR
SALT LAKE CITY UT
84132-0001
US

IV. Provider business mailing address

4252 W 6075 S
ROY UT
84067-9272
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-6255
  • Fax:
Mailing address:
  • Phone: 385-888-0434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number10224415-4405
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number10224415-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: