Healthcare Provider Details

I. General information

NPI: 1154949493
Provider Name (Legal Business Name): SAMANTHA HOWARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2020
Last Update Date: 10/22/2020
Certification Date: 08/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 W 100 S
SPANISH FORK UT
84660-5881
US

IV. Provider business mailing address

934 N LAREDO DR
SPANISH FORK UT
84660-6135
US

V. Phone/Fax

Practice location:
  • Phone: 801-798-7301
  • Fax: 801-798-8513
Mailing address:
  • Phone: 801-830-2927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9270018-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: