Healthcare Provider Details

I. General information

NPI: 1730734203
Provider Name (Legal Business Name): CAMERAN RACHELLE WILSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2019
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1492 E RIDGELINE DR STE 2
SOUTH OGDEN UT
84405-4103
US

IV. Provider business mailing address

1055 N 500 W ATT: CREDENTIALING
PROVO UT
84604
US

V. Phone/Fax

Practice location:
  • Phone: 801-866-0170
  • Fax: 801-866-0169
Mailing address:
  • Phone: 801-354-8225
  • Fax: 801-418-0941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number191477-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: