Healthcare Provider Details

I. General information

NPI: 1255881397
Provider Name (Legal Business Name): ARWEN CUNDICK YORK NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ARWEN ELIZABETH CUNDICK

II. Dates (important events)

Enumeration Date: 10/13/2016
Last Update Date: 12/20/2021
Certification Date: 12/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10433 S REDWOOD RD SUITE 2
SOUTH JORDAN UT
84095-8502
US

IV. Provider business mailing address

10433 S REDWOOD RD SUITE 2
SOUTH JORDAN UT
84095-8502
US

V. Phone/Fax

Practice location:
  • Phone: 801-260-1919
  • Fax: 801-260-1441
Mailing address:
  • Phone: 801-260-1919
  • Fax: 801-260-1441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7988124-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: