Healthcare Provider Details

I. General information

NPI: 1124678164
Provider Name (Legal Business Name): REBECCA MARIE BJORKMAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA MARIE CLARK

II. Dates (important events)

Enumeration Date: 09/11/2019
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11520 S REDWOOD RD
SOUTH JORDAN UT
84095-7805
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 385-887-6000
  • Fax:
Mailing address:
  • Phone: 385-887-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number8648998-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number8648998-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: