Healthcare Provider Details

I. General information

NPI: 1437003522
Provider Name (Legal Business Name): JONI RAE WIRTS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2026
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

654 S 900 E
SALT LAKE CITY UT
84102-3430
US

IV. Provider business mailing address

654 S 900 E
SALT LAKE CITY UT
84102-3430
US

V. Phone/Fax

Practice location:
  • Phone: 801-322-5571
  • Fax:
Mailing address:
  • Phone: 801-556-3844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number5523451-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: