Healthcare Provider Details

I. General information

NPI: 1932736758
Provider Name (Legal Business Name): ERIN WICE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 03/23/2020
Certification Date: 03/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3354 W 7800 S
WEST JORDAN UT
84088-4506
US

IV. Provider business mailing address

3534 S 6000 W
WEST VALLEY CITY UT
84128-2698
US

V. Phone/Fax

Practice location:
  • Phone: 801-282-2677
  • Fax:
Mailing address:
  • Phone: 801-969-6264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7163216-4408
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: