Healthcare Provider Details

I. General information

NPI: 1023209178
Provider Name (Legal Business Name): MONICA ANN BACHTELL NFP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 02/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

565 KOMAS DRIVE
SALT LAKE CITY UT
84108
US

IV. Provider business mailing address

565 KOMAS DRIVE
SALT LAKE CITY UT
84108
US

V. Phone/Fax

Practice location:
  • Phone: 801-584-5144
  • Fax: 801-584-5206
Mailing address:
  • Phone: 801-584-5144
  • Fax: 801-584-5206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number288898-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: