Healthcare Provider Details

I. General information

NPI: 1518583988
Provider Name (Legal Business Name): MELANIE ELISE HARRIS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2020
Last Update Date: 09/13/2021
Certification Date: 09/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E 3900 S STE 301
SALT LAKE CITY UT
84124-1350
US

IV. Provider business mailing address

434 W ASCENSION WAY STE 225
MURRAY UT
84123-2985
US

V. Phone/Fax

Practice location:
  • Phone: 385-831-6960
  • Fax:
Mailing address:
  • Phone: 801-716-7008
  • Fax: 888-990-1557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5253503
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: