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General NPI Number Information
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NPI Number | 1407453160
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Entity Type | Organization
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Legal Business Name | UTAH VALLEY NATURAL HEALTH CLINIC
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Dates
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Enumeration Date | 10/06/2020
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Last Update Date | 10/06/2020
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Provider Practice Location Address
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Address Line | 3311 N UNIVERSITY AVE STE 100
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City | PROVO
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State | UT
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Zip | 84604-7432
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Country | US
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Telephone | 801-374-5677
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Fax | 801-374-5675
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Provider Business Mailing Address
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Address Line | 3311 N UNIVERSITY AVE STE 100
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City | PROVO
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State | UT
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Zip | 84604-7432
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Country | US
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Telephone | 801-374-5677
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Fax | 801-374-5675
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. WHITNEY JANELLE MASSIMINI
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Credential |
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Telephone | 801-374-5677
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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