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General NPI Number Information
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NPI Number | 1417828971
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Entity Type | Organization
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Legal Business Name | BODY RENAISSANCE LLC
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Dates
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Enumeration Date | 09/16/2025
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Last Update Date | 10/13/2025
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Provider Practice Location Address
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Address Line | 86 S MAIN ST
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City | PAYSON
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State | UT
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Zip | 84651-2223
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Country | US
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Telephone | 385-501-1999
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Fax | 801-206-3338
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Provider Business Mailing Address
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Address Line | 742 N 350 E
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City | GENOLA
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State | UT
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Zip | 84655-8326
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Country | US
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Telephone | 385-510-5282
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Fax | 801-206-3338
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Authorized Official
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Title or Position | CREDENTIALING DIRECTOR
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Name | KARL F STEMMLER
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Credential | MPA
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Telephone | 619-258-6200
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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 |
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License Number State |
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