MEDICARE: MR. BENJAMIN N BOTCHWAY APRN, FNP-BC

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	337207-4405	UT

General Provider Information

NPI Number	:	1467698084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BENJAMIN N BOTCHWAY APRN, FNP-BC

Provider Business Mailing Address
First Line	:	1798 N STALLION LN
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84116-1115
Country	:	US
Telephone Number	:	801-440-8233
Fax Number	:	801-886-0956

Provider Business Practice Location Address
First Line	:	1640 W 500 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84104-5202
Country	:	US
Telephone Number	:	801-886-0930
Fax Number	:	801-886-0956

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

Provider Enumeration Date	:	01/02/2009
Last Update Date	:	12/18/2020

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