Healthcare Provider Details

I. General information

NPI: 1538989876
Provider Name (Legal Business Name): LAUREN NICOLE OGITANI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2024
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 W 400 S
SALT LAKE CITY UT
84101-1916
US

IV. Provider business mailing address

117 W 400 S
SALT LAKE CITY UT
84101-1916
US

V. Phone/Fax

Practice location:
  • Phone: 801-428-4257
  • Fax: 385-227-8362
Mailing address:
  • Phone: 801-428-4257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9870263-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: