Healthcare Provider Details

I. General information

NPI: 1902178650
Provider Name (Legal Business Name): MARK AARON ALDRIDGE FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2012
Last Update Date: 04/17/2023
Certification Date: 04/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 W 9000 S
SANDY UT
84070-2551
US

IV. Provider business mailing address

385 W 9000 S
SANDY UT
84070-2551
US

V. Phone/Fax

Practice location:
  • Phone: 801-562-5200
  • Fax:
Mailing address:
  • Phone: 801-562-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number9124468-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: