Healthcare Provider Details

I. General information

NPI: 1295625960
Provider Name (Legal Business Name): FAISA ADEN SMITH NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2025
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7410 S CREEK RD STE 100
SANDY UT
84093-6151
US

IV. Provider business mailing address

7410 S CREEK RD STE 100
SANDY UT
84093-6151
US

V. Phone/Fax

Practice location:
  • Phone: 801-816-1010
  • Fax:
Mailing address:
  • Phone: 801-816-1010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10440922-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: