Healthcare Provider Details

I. General information

NPI: 1972449387
Provider Name (Legal Business Name): STEPHANIE CARDOZO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

765 N MAIN ST
SPANISH FORK UT
84660-1113
US

IV. Provider business mailing address

3808 W 12240 S
PAYSON UT
84651-9662
US

V. Phone/Fax

Practice location:
  • Phone: 801-995-5554
  • Fax:
Mailing address:
  • Phone: 801-995-5554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number13389537-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: