Healthcare Provider Details

I. General information

NPI: 1538112214
Provider Name (Legal Business Name): JUDITH SAWAYA SAMPSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3215 VALLEY ST
SALT LAKE CITY UT
84109-4217
US

IV. Provider business mailing address

1225 FORT UNION BLVD SUITE 200
MIDVALE UT
84047-1889
US

V. Phone/Fax

Practice location:
  • Phone: 801-466-3102
  • Fax: 801-466-3576
Mailing address:
  • Phone: 801-233-4400
  • Fax: 801-233-4410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2173224405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: