Healthcare Provider Details

I. General information

NPI: 1245969708
Provider Name (Legal Business Name): MRS. VIVIAN HELEN WARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2022
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6321 S REDWOOD RD STE 200
SALT LAKE CITY UT
84123-6798
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 801-265-2212
  • Fax: 801-265-0103
Mailing address:
  • Phone: 801-265-2212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11020107
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number8471372-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: