Healthcare Provider Details

I. General information

NPI: 1932734753
Provider Name (Legal Business Name): DAVID MICHAEL NORD PAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2020
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1209 N MAIN ST UNIT B
TOOELE UT
84074-9841
US

IV. Provider business mailing address

96 E KIMBALLS LN STE 408
DRAPER UT
84020-5021
US

V. Phone/Fax

Practice location:
  • Phone: 435-775-8086
  • Fax: 435-775-2087
Mailing address:
  • Phone: 435-775-2086
  • Fax: 435-775-2087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number14272357-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: