Healthcare Provider Details

I. General information

NPI: 1235651506
Provider Name (Legal Business Name): ERIN MARIE CLOSE DNP, APRN, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2017
Last Update Date: 11/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 FOOTHILL DR
SALT LAKE CITY UT
84112-1106
US

IV. Provider business mailing address

2535 E KENSINGTON AVE
SALT LAKE CITY UT
84108-2417
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-6431
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9111038-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: