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General NPI Number Information
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NPI Number | 1861206229
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Entity Type | Individual
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Provider Name | EASTON ROBERTS
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Gender | Male
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Dates
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Enumeration Date | 02/05/2025
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 4403 HARRISON BLVD STE 1670
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City | OGDEN
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State | UT
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Zip | 84403-3306
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Country | US
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Telephone | 801-387-7150
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 27128
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City | SALT LAKE CITY
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State | UT
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Zip | 84127-0128
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Country | US
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Telephone |
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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 | 9256356-4405
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 9256356-4405
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License Number State | UT
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 9256356-3102
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License Number State | UT
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