Healthcare Provider Details

I. General information

NPI: 1215625611
Provider Name (Legal Business Name): MEGGAN ROTHE HULME FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2023
Last Update Date: 04/25/2023
Certification Date: 04/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N MARIO CAPECCHI DR
SALT LAKE CITY UT
84113-1103
US

IV. Provider business mailing address

100 N MARIO CAPECCHI DRIVE
SALT LAKE CITY UT
84113
US

V. Phone/Fax

Practice location:
  • Phone: 801-662-3577
  • Fax: 801-662-3588
Mailing address:
  • Phone: 801-662-3577
  • Fax: 801-662-3588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5620143-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: