=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730046053
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NATHAN UTLEY RN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/08/2026
-----------------------------------------------------
Last Update Date | 01/08/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3668 MITCHELL DR
-----------------------------------------------------
City | SANTA CLARA
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84765-5397
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 435-632-0204
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3668 MITCHELL DR
-----------------------------------------------------
City | SANTA CLARA
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84765-5397
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 435-632-0204
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WM1400X
-----------------------------------------------------
Taxonomy Name | Nurse Massage Therapist (NMT)
-----------------------------------------------------
License Number | 14197528-3102
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------