Healthcare Provider Details

I. General information

NPI: 1487761615
Provider Name (Legal Business Name): TRENAISA NAY CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10171 DELSEY CV
SOUTH JORDAN UT
84095-7108
US

IV. Provider business mailing address

10171 DELSEY CV
SOUTH JORDAN UT
84095-7108
US

V. Phone/Fax

Practice location:
  • Phone: 801-391-4585
  • Fax: 801-282-0313
Mailing address:
  • Phone: 801-391-4585
  • Fax: 801-282-0313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number200842-4405
License Number StateUT

VIII. Authorized Official

Name: TRENAISA NAY
Title or Position: GERIATRIC NURSE PRACTITIONER
Credential: NP
Phone: 801-391-4585