Healthcare Provider Details

I. General information

NPI: 1619162997
Provider Name (Legal Business Name): NADINE M MCCALL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NADINE M EARLEY

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 S MAIN ST
SALT LAKE CITY UT
84111-2176
US

IV. Provider business mailing address

111 S MAIN ST
SALT LAKE CITY UT
84111-2176
US

V. Phone/Fax

Practice location:
  • Phone: 801-884-1801
  • Fax:
Mailing address:
  • Phone: 801-884-1801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN259420
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP081033
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number13868099-4405
License Number StateUT
# 4
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number058235-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: