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General NPI Number Information
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NPI Number | 1124678164
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Entity Type | Individual
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Provider Name | REBECCA MARIE BJORKMAN APRN
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Gender | Female
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Dates
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Enumeration Date | 09/11/2019
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Last Update Date | 09/11/2019
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Provider Practice Location Address
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Address Line | 11520 S REDWOOD RD
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City | SOUTH JORDAN
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State | UT
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Zip | 84095-7805
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Country | US
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Telephone | 385-887-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 3698 W OAK CREST DR
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City | LEHI
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State | UT
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Zip | 84043-6625
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Country | US
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Telephone | 801-319-5986
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 8648998-4405
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License Number State | UT
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