Healthcare Provider Details

I. General information

NPI: 1538557830
Provider Name (Legal Business Name): PREMIER NURSING GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2015
Last Update Date: 04/09/2021
Certification Date: 04/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9980 S 300 W SUITE 200
SANDY UT
84070
US

IV. Provider business mailing address

9980 S 300 W SUITE 200
SANDY UT
84070
US

V. Phone/Fax

Practice location:
  • Phone: 801-733-9833
  • Fax:
Mailing address:
  • Phone: 801-733-9833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number2014-HHA-UT000631
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number2014-HHA-UT000631
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number2014-HHA-UT000631
License Number StateUT

VIII. Authorized Official

Name: GINA LIVINGSTON
Title or Position: OWNER
Credential: FNP-BGRN, IQCN
Phone: 801-733-9833