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General NPI Number Information
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NPI Number | 1871203414
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Entity Type | Organization
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Legal Business Name | NOORDA COLLEGE OF OSTEOPATHIC
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Dates
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Enumeration Date | 12/05/2022
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Last Update Date | 11/26/2024
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Provider Practice Location Address
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Address Line | 2162 SOUTH 180 EAST, STE 1000
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City | PROVO
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State | UT
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Zip | 84606
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Country | US
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Telephone | 385-380-3425
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Fax |
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Provider Business Mailing Address
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Address Line | 2162 S 180 E STE 1000
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City | PROVO
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State | UT
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Zip | 84606-7370
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Country | US
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Telephone | 385-380-3425
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Fax | 855-873-2517
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Authorized Official
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Title or Position | DIRECTOR OF CLINICAL OPERATIONS
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Name | JENNIFER SHUMWAY
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Credential |
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Telephone | 801-380-0015
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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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Taxonomy #2
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Taxonomy Code | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number |
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License Number State |
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