Healthcare Provider Details

I. General information

NPI: 1144994344
Provider Name (Legal Business Name): NANCY MARIE RAYMOND PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2021
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9103 S 1300 W STE 102
WEST JORDAN UT
84088-6709
US

IV. Provider business mailing address

PO BOX 396
SPRINGBORO OH
45066-0396
US

V. Phone/Fax

Practice location:
  • Phone: 801-417-0131
  • Fax:
Mailing address:
  • Phone: 801-674-5668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10858695-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: