Healthcare Provider Details

I. General information

NPI: 1457847675
Provider Name (Legal Business Name): ALISHA WURSTEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2018
Last Update Date: 07/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 E 7000 S
SALT LAKE CITY UT
84121-6894
US

IV. Provider business mailing address

1096 S 1100 E
SALT LAKE CITY UT
84105-1542
US

V. Phone/Fax

Practice location:
  • Phone: 801-943-3300
  • Fax:
Mailing address:
  • Phone: 801-598-7841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number333676-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: