Healthcare Provider Details

I. General information

NPI: 1831422799
Provider Name (Legal Business Name): SHELLEY REYNOLDS TREUHAFT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2009
Last Update Date: 09/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N 1900 E 3C127 SCIENCE OF MEDICINE
SALT LAKE CITY UT
84132-0002
US

IV. Provider business mailing address

30 N 1900 E 3C127 SCIENCE OF MEDICINE
SALT LAKE CITY UT
84132-0002
US

V. Phone/Fax

Practice location:
  • Phone: 801-585-3936
  • Fax: 801-585-3936
Mailing address:
  • Phone: 801-585-3936
  • Fax: 801-585-3936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number212133-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: