Healthcare Provider Details

I. General information

NPI: 1639826043
Provider Name (Legal Business Name): YOUR IN HOME NP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2022
Last Update Date: 03/05/2022
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3269 S MAIN ST STE 220
SOUTH SALT LAKE UT
84115-3767
US

IV. Provider business mailing address

358 S 700 EAST STE B #333
SALT LAKE CITY UT
84102-1446
US

V. Phone/Fax

Practice location:
  • Phone: 385-212-4358
  • Fax:
Mailing address:
  • Phone: 385-212-4358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LEIGH-ANDREW THOMAS SAMPSON-SEITZ
Title or Position: OWNER
Credential: FNP
Phone: 385-212-4358