MEDICARE: HEATHER MISSY BERKEL APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	3083662-4405	UT

General Provider Information

NPI Number	:	1326372764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER MISSY BERKEL APRN

Provider Business Mailing Address
First Line	:	1906 W 3600 S
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84119-4715
Country	:	US
Telephone Number	:	801-973-9675
Fax Number	:

Provider Business Practice Location Address
First Line	:	1906 W 3600 S
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84119-4715
Country	:	US
Telephone Number	:	801-973-9675
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/01/2009
Last Update Date	:	11/18/2016

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