Healthcare Provider Details

I. General information

NPI: 1881555357
Provider Name (Legal Business Name): MEDICAL PREP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 N GOULD ST
SHERIDAN WY
82801-6317
US

IV. Provider business mailing address

1799 S WASATCH DR
SALT LAKE CITY UT
84108-3360
US

V. Phone/Fax

Practice location:
  • Phone: 628-282-5882
  • Fax:
Mailing address:
  • Phone: 628-282-5882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State

VIII. Authorized Official

Name: NATHAN RESNICK
Title or Position: OWNER
Credential:
Phone: 628-282-5882