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General NPI Number Information
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NPI Number | 1386485621
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Entity Type | Individual
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Provider Name | MATHEW CHRISTOPHER PEDERSEN DNP FNP-BC
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Gender | Male
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Dates
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Enumeration Date | 06/03/2024
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Last Update Date | 06/03/2024
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Provider Practice Location Address
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Address Line | 1748 W 1800 N
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City | CLINTON
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State | UT
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Zip | 84015-8324
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Country | US
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Telephone | 180-177-3164
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Fax |
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Provider Business Mailing Address
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Address Line | 134 E SHADOWBROOK LN
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City | KAYSVILLE
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State | UT
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Zip | 84037-2892
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Country | US
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Telephone | 801-888-7495
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 8677181-4405
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License Number State | UT
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