Healthcare Provider Details

I. General information

NPI: 1801326137
Provider Name (Legal Business Name): EVA MARIA COMOLLO ANGERHOFER FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2017
Last Update Date: 07/21/2022
Certification Date: 04/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 W 600 N
SLC UT
84103-1315
US

IV. Provider business mailing address

520 W 190TH ST APT 2B
NEW YORK NY
10040-3408
US

V. Phone/Fax

Practice location:
  • Phone: 801-819-9155
  • Fax:
Mailing address:
  • Phone: 801-819-9155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number10515010-3102
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number718147
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number718147-1
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10515010-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: