Healthcare Provider Details

I. General information

NPI: 1285256453
Provider Name (Legal Business Name): SALLY BOWEN FNP, APRN, AAHIVS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2020
Last Update Date: 07/20/2023
Certification Date: 07/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S 1000 E STE 200
SALT LAKE CITY UT
84102-1496
US

IV. Provider business mailing address

150 S 1000 E
SALT LAKE CITY UT
84102-1443
US

V. Phone/Fax

Practice location:
  • Phone: 801-487-2323
  • Fax:
Mailing address:
  • Phone: 801-487-2323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number128982634405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.1622426
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0995377-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: