Healthcare Provider Details

I. General information

NPI: 1720584147
Provider Name (Legal Business Name): LEIGH SIMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2018
Last Update Date: 07/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9450 S 1300 E
SANDY UT
84094
US

IV. Provider business mailing address

10473 S GLADYS DR
SOUTH JORDAN UT
84095-2773
US

V. Phone/Fax

Practice location:
  • Phone: 801-501-2100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number8340881-3102
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number8340881-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: