Healthcare Provider Details

I. General information

NPI: 1720527245
Provider Name (Legal Business Name): HELEN POWELL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2017
Last Update Date: 04/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3838 S 700 E STE 100
SALT LAKE CITY UT
84106-1466
US

IV. Provider business mailing address

1121 E 3900 S SUITE 100
SALT LAKE CITY UT
84124-1214
US

V. Phone/Fax

Practice location:
  • Phone: 801-269-0231
  • Fax: 801-269-0304
Mailing address:
  • Phone: 801-262-9494
  • Fax: 866-415-6807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9166666-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: