Healthcare Provider Details

I. General information

NPI: 1518561950
Provider Name (Legal Business Name): NANCY FREESTONE NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2020
Last Update Date: 12/17/2021
Certification Date: 12/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3556 W 9800 S STE 10
SOUTH JORDAN UT
84095-3211
US

IV. Provider business mailing address

1130 E 2700 S APT K88
SLC UT
84106-2636
US

V. Phone/Fax

Practice location:
  • Phone: 801-567-9780
  • Fax:
Mailing address:
  • Phone: 801-440-6764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6176768-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: