Healthcare Provider Details

I. General information

NPI: 1700821378
Provider Name (Legal Business Name): SALLY ANN LOKEN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 FOOTHILL BLVD
SALT LAKE CITY UT
84148-0001
US

IV. Provider business mailing address

4024 PARKVIEW DR
SALT LAKE CITY UT
84124-3419
US

V. Phone/Fax

Practice location:
  • Phone: 801-582-1565
  • Fax: 801-584-2503
Mailing address:
  • Phone: 801-272-6782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number204741-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: