Healthcare Provider Details

I. General information

NPI: 1801553060
Provider Name (Legal Business Name): JAMIE L WOODBURY NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2021
Last Update Date: 11/23/2021
Certification Date: 11/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 S 3000 W
WEST POINT UT
84015-7414
US

IV. Provider business mailing address

PO BOX 5546
DENVER CO
80217-5546
US

V. Phone/Fax

Practice location:
  • Phone: 801-475-3960
  • Fax: 801-475-3961
Mailing address:
  • Phone: 801-475-3500
  • Fax: 801-475-3494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number9259962-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: