Healthcare Provider Details

I. General information

NPI: 1386375434
Provider Name (Legal Business Name): CLAIRE ESCOVAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2022
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 S 2000 E
SLC UT
84112-5880
US

IV. Provider business mailing address

10 S 2000 E
SALT LAKE CITY UT
84112-5880
US

V. Phone/Fax

Practice location:
  • Phone: 801-550-6858
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number11765735-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: