Healthcare Provider Details

I. General information

NPI: 1578058764
Provider Name (Legal Business Name): NATALIE MINER-GOECKERITZ FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NATALIE ORGAN

II. Dates (important events)

Enumeration Date: 06/29/2018
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

389 S 900 E
SALT LAKE CITY UT
84102-2310
US

IV. Provider business mailing address

569 E TILDEN PARC LN UNIT 1101
DRAPER UT
84020-6326
US

V. Phone/Fax

Practice location:
  • Phone: 385-282-2700
  • Fax: 385-282-2701
Mailing address:
  • Phone: 435-340-8204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number8669658-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: