Healthcare Provider Details

I. General information

NPI: 1083852677
Provider Name (Legal Business Name): JILL STRATFORD WALDRON APRN, GNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2009
Last Update Date: 12/16/2021
Certification Date: 12/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 NORTH MEDICAL DRIVE UNIVERSITY OF UTAH CARDIOLOGY CLINIC #10
SALT LAKE CITY UT
84132
US

IV. Provider business mailing address

30 NORTH 1900 EAST ROOM 4A100
SALT LAKE CITY UT
84132
US

V. Phone/Fax

Practice location:
  • Phone: 801-585-5122
  • Fax: 801-585-2319
Mailing address:
  • Phone: 801-585-5122
  • Fax: 801-585-2319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number2794904405
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number279490-4405/APRN
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: