Healthcare Provider Details

I. General information

NPI: 1134570328
Provider Name (Legal Business Name): HOPE FAMILY MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2016
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 E 5900 S STE B109
SALT LAKE CITY UT
84107-7293
US

IV. Provider business mailing address

166 E 5900 S STE B109
SALT LAKE CITY UT
84107-7293
US

V. Phone/Fax

Practice location:
  • Phone: 385-275-4673
  • Fax:
Mailing address:
  • Phone: 385-275-4673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2231894405
License Number StateUT

VIII. Authorized Official

Name: GERALDINE JODY STUBLER
Title or Position: MEDICAL DIRECTOR
Credential: FNP-C
Phone: 385-275-4673