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General NPI Number Information
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NPI Number | 1588434716
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Entity Type | Individual
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Provider Name | CHIA-I LI AGACNP-BC
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Gender | Female
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Dates
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Enumeration Date | 01/08/2024
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Last Update Date | 01/08/2024
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Provider Practice Location Address
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Address Line | 50 N MEDICAL DR
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City | SALT LAKE CITY
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State | UT
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Zip | 84132-0001
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Country | US
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Telephone | 801-581-2121
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Fax |
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Provider Business Mailing Address
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Address Line | 2079 S 1200 E APT S502
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City | SALT LAKE CITY
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State | UT
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Zip | 84105-3580
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Country | US
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Telephone | 812-351-0599
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 2023129113
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 13196921-3102
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License Number State | UT
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