Healthcare Provider Details

I. General information

NPI: 1558246090
Provider Name (Legal Business Name): REEM HEAVEN NEV BAHAR PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2025
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2531 S 400 E
SOUTH SALT LAKE UT
84115-3305
US

IV. Provider business mailing address

1512 S 300 W APT 412 APT 412
SALT LAKE CITY UT
84115-4124
US

V. Phone/Fax

Practice location:
  • Phone: 801-634-0581
  • Fax:
Mailing address:
  • Phone: 801-634-0581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number110850731
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number6040-35206637
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License NumberSL-8826
License Number StateUT
# 5
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateUT
# 6
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number7244713
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: