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General NPI Number Information
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NPI Number | 1396499414
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Entity Type | Organization
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Legal Business Name | WASATCH FUNCTIONAL MEDICINE
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Dates
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Enumeration Date | 02/08/2022
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Last Update Date | 02/08/2022
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Provider Practice Location Address
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Address Line | 5711 S 1475 E STE 201
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City | SOUTH OGDEN
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State | UT
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Zip | 84403-5185
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Country | US
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Telephone | 801-332-9034
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Fax |
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Provider Business Mailing Address
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Address Line | 5711 S 1475 E STE 201
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City | SOUTH OGDEN
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State | UT
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Zip | 84403-5185
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Country | US
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Telephone | 801-332-9034
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Fax |
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Authorized Official
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Title or Position | OWNER/NURSE PRACTITIONER
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Name | CATHERINE KELLY PIERCE
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Credential | FNP-C
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Telephone | 801-332-9034
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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