Healthcare Provider Details

I. General information

NPI: 1508054776
Provider Name (Legal Business Name): GRETCHEN LEATHERS ALEXANDER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GRETCHEN LEATHERS RN

II. Dates (important events)

Enumeration Date: 10/12/2007
Last Update Date: 05/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 FOOTHILL BLVD
SALT LAKE CITY UT
84148-0001
US

IV. Provider business mailing address

14185 N 3100 W
COLLINSTON UT
84306-9749
US

V. Phone/Fax

Practice location:
  • Phone: 801-479-4105
  • Fax: 801-584-2540
Mailing address:
  • Phone: 435-279-6755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number292960-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: