Healthcare Provider Details

I. General information

NPI: 1346474749
Provider Name (Legal Business Name): BJORN A. NORDSTROM D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2009
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 E MILL RD STE 303
VINEYARD UT
84059-5730
US

IV. Provider business mailing address

707 E MILL RD STE 303
VINEYARD UT
84059-5730
US

V. Phone/Fax

Practice location:
  • Phone: 801-224-1301
  • Fax: 801-225-3236
Mailing address:
  • Phone: 801-224-1300
  • Fax: 801-224-1300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number10191817-1204
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: