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General NPI Number Information
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NPI Number | 1093638249
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Entity Type | Organization
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Legal Business Name | SANAVERA MEDICAL LLC
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Dates
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Enumeration Date | 08/04/2026
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Last Update Date | 08/04/2026
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Provider Practice Location Address
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Address Line | 6626B W WIDE HOLLOW DR
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City | HERRIMAN
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State | UT
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Zip | 84096-3550
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Country | US
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Telephone | 661-992-3146
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Fax |
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Provider Business Mailing Address
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Address Line | 7533 S CENTER VIEW CT # 6273
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City | WEST JORDAN
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State | UT
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Zip | 84084-5526
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Country | US
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Telephone | 661-992-3146
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KATHLEEN MITCHELL
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Credential | FNP
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Telephone | 661-992-3146
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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