Healthcare Provider Details

I. General information

NPI: 1114286010
Provider Name (Legal Business Name): EILEEN FOTI R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2012
Last Update Date: 05/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 FOOTHILL BLVD
SALT LAKE CITY UT
84148-0001
US

IV. Provider business mailing address

500 FOOTHILL BLVD
SALT LAKE CITY UT
84148-0001
US

V. Phone/Fax

Practice location:
  • Phone: 801-582-1565
  • Fax: 801-584-5694
Mailing address:
  • Phone: 801-582-1565
  • Fax: 801-584-5694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number370899-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: