Healthcare Provider Details

I. General information

NPI: 1972553014
Provider Name (Legal Business Name): HILARY FAE SAUNDERS A.P.R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HILARY FAE ISENHOUR A.P.R,N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 12/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MARIO CAPECCHI DR
SALT LAKE CITY UT
84113-1103
US

IV. Provider business mailing address

100 MARIO CAPECCHI DR
SALT LAKE CITY UT
84113-1103
US

V. Phone/Fax

Practice location:
  • Phone: 801-662-5340
  • Fax:
Mailing address:
  • Phone: 801-662-5340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number190665-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number190665-4405
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number190665-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: