Healthcare Provider Details

I. General information

NPI: 1518516210
Provider Name (Legal Business Name): CUICUI ZHANG APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2019
Last Update Date: 05/29/2020
Certification Date: 05/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8686 S 1300 E # L102L104
SANDY UT
84094-1947
US

IV. Provider business mailing address

8686 S 1300 E # L102L104
SANDY UT
84094-1947
US

V. Phone/Fax

Practice location:
  • Phone: 801-997-0368
  • Fax: 801-382-7898
Mailing address:
  • Phone: 801-997-0368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number7716092-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7716092-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: