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General NPI Number Information
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NPI Number | 1982412375
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Entity Type | Organization
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Legal Business Name | WASATCH NP HOUSE CALLS LLC
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Dates
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Enumeration Date | 12/18/2024
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Last Update Date | 12/18/2024
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Provider Practice Location Address
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Address Line | 3907 SILVER SPUR CIR
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City | PARK CITY
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State | UT
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Zip | 84098-4819
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Country | US
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Telephone | 801-252-5209
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Fax |
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Provider Business Mailing Address
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Address Line | 50 W BROADWAY STE 333
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City | SALT LAKE CITY
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State | UT
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Zip | 84101-2027
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Country | US
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Telephone | 801-252-5209
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KAITLYN PELLETIER
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Credential |
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Telephone | 801-252-5209
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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