Healthcare Provider Details

I. General information

NPI: 1457839631
Provider Name (Legal Business Name): NATALIE DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2018
Last Update Date: 12/09/2021
Certification Date: 12/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11260 S RIVER HEIGHTS DR
SOUTH JORDAN UT
84095-5119
US

IV. Provider business mailing address

12001 S CORTINA CREST DR
DRAPER UT
84020-6106
US

V. Phone/Fax

Practice location:
  • Phone: 801-298-2000
  • Fax:
Mailing address:
  • Phone: 801-875-3949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12348461-3502
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: