Healthcare Provider Details

I. General information

NPI: 1629444666
Provider Name (Legal Business Name): JOSELYN FULLER FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JOSELYN LONDER FNP-BC

II. Dates (important events)

Enumeration Date: 08/13/2015
Last Update Date: 04/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3580 W 9000 SOUTH
WEST JORDAN UT
84088-8899
US

IV. Provider business mailing address

PO BOX 96398
OKLAHOMA CITY OK
73143-6398
US

V. Phone/Fax

Practice location:
  • Phone: 801-561-8888
  • Fax:
Mailing address:
  • Phone: 800-962-3303
  • Fax: 405-609-1466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number7327150
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7327150-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: