Healthcare Provider Details

I. General information

NPI: 1710810056
Provider Name (Legal Business Name): JAKOB PARKER VANDER LINDEN RN, BSN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JAKOB PARKER VANDERLINDEN

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 W 800 S
WILLARD UT
84340-6758
US

IV. Provider business mailing address

251 W 800 S
WILLARD UT
84340-6758
US

V. Phone/Fax

Practice location:
  • Phone: 801-946-6089
  • Fax:
Mailing address:
  • Phone: 801-946-6089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: