Healthcare Provider Details

I. General information

NPI: 1124046834
Provider Name (Legal Business Name): CAROL J. HUGHES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 FOOTHILL BLVD #182
SALT LAKE CITY UT
84148-0001
US

IV. Provider business mailing address

2755 E 3220 S
SALT LAKE CITY UT
84109-2814
US

V. Phone/Fax

Practice location:
  • Phone: 801-582-1565
  • Fax: 801-584-5640
Mailing address:
  • Phone: 801-466-7346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number224902-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: