Healthcare Provider Details

I. General information

NPI: 1447746532
Provider Name (Legal Business Name): THOMAS ROWLEY FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2018
Last Update Date: 07/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 S 2000 E
SALT LAKE CITY UT
84112-5880
US

IV. Provider business mailing address

10958 PORCINI DR.
SOUTH JORDAN UT
84009
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-3414
  • Fax:
Mailing address:
  • Phone: 801-707-3341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6676082-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: